1.1 	A bill for an act
1.2 	relating to human services; modifying provisions governing behavioral health 
1.3 	home services and medical respite health home services; appropriating money;
1.4 	amending Minnesota Statutes 2018, section 256B.0757, subdivisions 1, 2, 4, 5, 8, 
1.5 	by adding subdivisions.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2018, section 256B.0757, subdivision 1, is amended to read:
1.8 		Subdivision 1.Provision of coverage. (a) The commissioner shall provide medical 
1.9 	assistance coverage of health home services for eligible individuals with chronic conditions 
1.10 	who select a designated provider as the individual's health home.
1.11 	(b) The commissioner shall implement this section in compliance with the requirements 
1.12 	of the state option to provide health homes for enrollees with chronic conditions, as provided 
1.13 	under the Patient Protection and Affordable Care Act, Public Law 111-148, sections 2703 
1.14 	and 3502. Terms used in this section have the meaning provided in that act.
1.15 	(c) The commissioner shall establish health homes to serve populations with serious 
1.16 	mental illness who meet the eligibility requirements described under subdivision 2, paragraph 
1.17 	(b) clause (4) (1). The health home services provided by health homes shall focus on both 
1.18 	the behavioral and the physical health of these populations.
1.19 	(d) The commissioner shall establish medical respite health homes to serve individuals 
1.20 	who are homeless and meet the eligibility requirements described under subdivision 2, 
1.21 	paragraph (b), clause (2). The commissioner shall work with stakeholders to develop 
1.22 	eligibility requirements, provider qualification requirements, and service delivery 
1.23 	requirements.

2.1 	EFFECTIVE DATE. This section is effective upon federal approval. The commissioner 
2.2 	shall notify the revisor of statutes when federal approval has been obtained.

2.3 	Sec. 2. Minnesota Statutes 2018, section 256B.0757, subdivision 2, is amended to read:
2.4 		Subd. 2.Eligible individual. (a) The commissioner may develop health home models 
2.5 	in accordance with United States Code, title 42, section 1396w-4(h)(1).
2.6 	(b) An individual is eligible for health home services under this section if the individual 
2.7 	is eligible for medical assistance under this chapter and has at least:
2.8 	(1) two chronic conditions;
2.9 	(2) one chronic condition and is at risk of having a second chronic condition;
2.10 	(3) one serious and persistent mental health condition; or
2.11 	(4) (1) has a condition that meets the definition of serious mental illness as described in 
2.12 	section 245.462, subdivision 20, paragraph (a), or emotional disturbance as defined in section
2.13 	245.4871, subdivision 15, clause (2); and has a current diagnostic assessment as defined in 
2.14 	Minnesota Rules, part 9505.0372, subpart 1, item B or C, as performed or reviewed by a 
2.15 	mental health professional employed by or under contract with the behavioral health home
2.16 	or
2.17 	(2) the individual is homeless. For purposes of this clause, an individual is homeless if 
2.18 	the individual lacks a fixed, adequate night-time residence.
2.19 	The commissioner shall establish criteria for determining continued eligibility.

2.20 	EFFECTIVE DATE. This section is effective the day following final enactment.

2.21 	Sec. 3. Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision 
2.22 	to read:
2.23 		Subd. 2a.Discharge criteria. (a) An individual may be discharged from behavioral 
2.24 	health home services if:
2.25 	(1) the behavioral health home services provider is unable to locate, contact, and engage 
2.26 	the individual for a period of greater than three months after persistent efforts by the 
2.27 	behavioral health home services provider; or
2.28 	(2) the individual is unwilling to participate in behavioral health home services as 
2.29 	demonstrated by the individual's refusal to meet with the behavioral health home services 
3.1 	provider, or refusal to identify the individual's health and wellness goals or the activities or 
3.2 	support necessary to achieve these goals.
3.3 	(b) Before discharge from behavioral health home services, the behavioral health home 
3.4 	services provider must offer a face-to-face meeting with the individual and the individual's 
3.5 	identified supports, to discuss options available to the individual, including maintaining 
3.6 	behavioral health home services.

3.7 	EFFECTIVE DATE. This section is effective the day following final enactment.

3.8 	Sec. 4. Minnesota Statutes 2018, section 256B.0757, subdivision 4, is amended to read:
3.9 		Subd. 4.Designated provider. (a) Health home services are voluntary and an eligible 
3.10 	individual may choose any designated provider. The commissioner shall establish designated 
3.11 	providers to serve as health homes and provide the services described in subdivision 3 to 
3.12 	individuals eligible under subdivision 2. The commissioner shall apply for grants as provided 
3.13 	under section 3502 of the Patient Protection and Affordable Care Act to establish health 
3.14 	homes and provide capitated payments to designated providers. For purposes of this section, 
3.15 	"designated provider" means a provider, clinical practice or clinical group practice, rural 
3.16 	clinic, community health center, community mental health center, or any other entity that 
3.17 	is determined by the commissioner to be qualified to be a health home for eligible individuals. 
3.18 	This determination must be based on documentation evidencing that the designated provider 
3.19 	has the systems and infrastructure in place to provide health home services and satisfies the 
3.20 	qualification standards established by the commissioner in consultation with stakeholders 
3.21 	and approved by the Centers for Medicare and Medicaid Services.
3.22 	(b) The commissioner shall develop and implement certification standards for designated 
3.23 	providers under this subdivision.

3.24 	EFFECTIVE DATE. This section is effective the day following final enactment.

3.25 	Sec. 5. Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision 
3.26 	to read:
3.27 		Subd. 4a.Behavioral health home services provider requirements. A behavioral 
3.28 	health home services provider must:
3.29 	(1) be an enrolled Minnesota Health Care Programs provider;
3.30 	(2) provide a medical assistance covered primary care or behavioral health service;
3.31 	(3) utilize an electronic health record;
4.1 	(4) utilize an electronic patient registry that contains the data elements required by the 
4.2 	commissioner;
4.3 	(5) demonstrate the organization's capacity to administer screenings approved by the 
4.4 	commissioner for substance use disorder or alcohol and tobacco use;
4.5 	(6) demonstrate the organization's capacity to refer an individual to resources appropriate 
4.6 	to the individual's screening results;
4.7 	(7) have policies and procedures to track referrals to ensure that the referral met the 
4.8 	individual's needs;
4.9 	(8) conduct a brief needs assessment when an individual begins receiving behavioral 
4.10 	health home services. The brief needs assessment must be completed with input from the 
4.11 	individual and the individual's identified supports. The brief needs assessment must address 
4.12 	the individual's immediate safety and transportation needs and potential barriers to 
4.13 	participating in behavioral health home services;
4.14 	(9) conduct a health wellness assessment within 60 days after intake that contains all 
4.15 	required elements identified by the commissioner;
4.16 	(10) conduct a health action plan that contains all required elements identified by the 
4.17 	commissioner. The plan must be completed within 90 days after intake and must be updated 
4.18 	at least once every six months, or more frequently if significant changes to an individual's 
4.19 	needs or goals occur;
4.20 	(11) agree to cooperate with and participate in the state's monitoring and evaluation of 
4.21 	behavioral health home services; and
4.22 	(12) obtain the individual's written consent to begin receiving behavioral health home 
4.23 	services using a form approved by the commissioner.

4.24 	EFFECTIVE DATE. This section is effective the day following final enactment.

4.25 	Sec. 6. Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision 
4.26 	to read:
4.27 		Subd. 4b.Behavioral health home provider training and practice transformation 
4.28 	requirements. (a) The behavioral health home services provider must ensure that all staff 
4.29 	delivering behavioral health home services receive adequate preservice and ongoing training, 
4.30 	including:
4.31 	(1) training approved by the commissioner that describes the goals and principles of 
4.32 	behavioral health home services; and
5.1 	(2) training on evidence-based practices to promote an individual's ability to successfully 
5.2 	engage with medical, behavioral health, and social services to achieve the individual's health 
5.3 	and wellness goals.
5.4 	(b) The behavioral health home services provider must ensure that staff are capable of 
5.5 	implementing culturally responsive services, as determined by the individual's culture, 
5.6 	beliefs, values, and language as identified in the individual's health wellness assessment.
5.7 	(c) The behavioral health home services provider must participate in the department's 
5.8 	practice transformation activities to support continued skill and competency development 
5.9 	in the provision of integrated medical, behavioral health, and social services.

5.10 	EFFECTIVE DATE. This section is effective the day following final enactment.

5.11 	Sec. 7. Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision 
5.12 	to read:
5.13 		Subd. 4c.Behavioral health home staff qualifications. (a) A behavioral health home 
5.14 	services provider must maintain staff with required professional qualifications appropriate 
5.15 	to the setting.
5.16 	(b) If behavioral health home services are offered in a mental health setting, the 
5.17 	integration specialist must be a registered nurse licensed under the Minnesota Nurse Practice 
5.18 	Act, sections 148.171 to 148.285.
5.19 	(c) If behavioral health home services are offered in a primary care setting, the integration 
5.20 	specialist must be a mental health professional as defined in section 245.462, subdivision 
5.21 	18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6).
5.22 	(d) If behavioral health home services are offered in either a primary care setting or 
5.23 	mental health setting, the systems navigator must be a mental health practitioner as defined 
5.24 	in section 245.462, subdivision 17, or a community health worker as defined in section 
5.25 	256B.0625, subdivision 49.
5.26 	(e) If behavioral health home services are offered in either a primary care setting or 
5.27 	mental health setting, the qualified health home specialist must be one of the following:
5.28 	(1) a peer support specialist as defined in section 256B.0615;
5.29 	(2) a family peer support specialist as defined in section 256B.0616;
5.30 	(3) a case management associate as defined in section 245.462, subdivision 4, paragraph 
5.31 	(g), or 245.4871, subdivision 4, paragraph (j);
6.1 	(4) a mental health rehabilitation worker as defined in section 256B.0623, subdivision 
6.2 	5, clause (4);
6.3 	(5) a community paramedic as defined in section 144E.28, subdivision 9;
6.4 	(6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5); 
6.5 	or
6.6 	(7) a community health worker as defined in section 256B.0625, subdivision 49.

6.7 	EFFECTIVE DATE. This section is effective the day following final enactment.

6.8 	Sec. 8. Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision 
6.9 	to read:
6.10 		Subd. 4d.Behavioral health home service delivery standards. (a) A behavioral health 
6.11 	home services provider must meet the following service delivery standards:
6.12 	(1) establish and maintain processes to support the coordination of an individual's primary 
6.13 	care, behavioral health, and dental care;
6.14 	(2) maintain a team-based model of care, including regular coordination and 
6.15 	communication between behavioral health home services team members;
6.16 	(3) use evidence-based practices that recognize and are tailored to the medical, social, 
6.17 	economic, behavioral health, functional impairment, cultural, and environmental factors 
6.18 	affecting the individual's health and health care choices;
6.19 	(4) use person-centered planning practices to ensure the individual's health action plan 
6.20 	accurately reflects the individual's preferences, goals, resources, and optimal outcomes for 
6.21 	the individual and the individual's identified supports;
6.22 	(5) use the patient registry to identify individuals and population subgroups requiring 
6.23 	specific levels or types of care and provide or refer the individual to needed treatment, 
6.24 	intervention, or services;
6.25 	(6) utilize the Department of Human Services Partner Portal to identify past and current 
6.26 	treatment or services and identify potential gaps in care;
6.27 	(7) deliver services consistent with the standards for frequency and face-to-face contact 
6.28 	required by the commissioner;
6.29 	(8) ensure that a diagnostic assessment is completed for each individual receiving 
6.30 	behavioral health home services within six months of the start of behavioral health home 
6.31 	services;
7.1 	(9) deliver services in locations and settings that meet the needs of the individual;
7.2 	(10) provide a central point of contact to ensure that individuals and the individual's 
7.3 	identified supports can successfully navigate the array of services that impact the individual's 
7.4 	health and well-being;
7.5 	(11) have capacity to assess an individual's readiness for change and the individual's 
7.6 	capacity to integrate new health care or community supports into the individual's life;
7.7 	(12) offer or facilitate the provision of wellness and prevention education on 
7.8 	evidenced-based curriculums specific to the prevention and management of common chronic 
7.9 	conditions;
7.10 	(13) help an individual set up and prepare for medical, behavioral health, social service, 
7.11 	or community support appointments, including accompanying the individual to appointments 
7.12 	as appropriate, and providing follow-up with the individual after these appointments;
7.13 	(14) offer or facilitate the provision of health coaching related to chronic disease 
7.14 	management and the navigation of complex systems of care to the individual, the individual's 
7.15 	family, and identified supports;
7.16 	(15) connect the individual, the individual's family, and identified supports to appropriate 
7.17 	support services that help the individual overcome access or service barriers, increase 
7.18 	self-sufficiency skills, and improve overall health;
7.19 	(16) provide effective referrals and timely access to services; and
7.20 	(17) establish a continuous quality improvement process for providing behavioral health 
7.21 	home services.
7.22 	(b) The behavioral health home services provider must also create a plan, in partnership 
7.23 	with the individual and the individual's identified supports, to support the individual after 
7.24 	discharge from a hospital, residential treatment program, or other setting. The plan must 
7.25 	include protocols for:
7.26 	(1) maintaining contact between the behavioral health home services team member, the 
7.27 	individual, and the individual's identified supports during and after discharge;
7.28 	(2) linking the individual to new resources as needed;
7.29 	(3) reestablishing the individual's existing services and community and social supports; 
7.30 	and
7.31 	(4) following up with appropriate entities to transfer or obtain the individual's service 
7.32 	records as necessary for continued care.
8.1 	(c) If the individual is enrolled in a managed care plan, a behavioral health home services 
8.2 	provider must:
8.3 	(1) notify the behavioral health home services contact designated by the managed care 
8.4 	plan within 30 days of when the individual begins behavioral health home services; and
8.5 	(2) adhere to the managed care plan communication and coordination requirements 
8.6 	described in the behavioral health home services manual.
8.7 	(d) Before terminating behavioral health home services, the behavioral health home 
8.8 	services provider must:
8.9 	(1) provide a 60-day notice of termination of behavioral health home services to all 
8.10 	individuals receiving behavioral health home services, the commissioner, and managed care 
8.11 	plans, if applicable; and
8.12 	(2) refer individuals receiving behavioral health home services to a new behavioral 
8.13 	health home services provider.

8.14 	Sec. 9. Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision 
8.15 	to read:
8.16 		Subd. 4e.Behavioral health home provider variances. (a) The commissioner may 
8.17 	grant a variance to specific requirements under subdivisions 4a, 4b, 4c, or 4d for a behavioral 
8.18 	health home services provider according to this subdivision.
8.19 	(b) The commissioner may grant a variance if the commissioner finds that:
8.20 	(1) failure to grant the variance would result in hardship or injustice to the applicant;
8.21 	(2) the variance would be consistent with the public interest; and
8.22 	(3) the variance would not reduce the level of services provided to individuals served 
8.23 	by the organization.
8.24 	(c) The commissioner may grant a variance from one or more requirements to permit 
8.25 	an applicant to offer behavioral health home services of a type or in a manner that is 
8.26 	innovative, if the commissioner finds that the variance does not impede the achievement of 
8.27 	the criteria in subdivisions 4a, 4b, 4c, or 4d and may improve the behavioral health home 
8.28 	services provided by the applicant.
8.29 	(d) The commissioner's decision to grant or deny a variance request is final and not 
8.30 	subject to appeal.

8.31 	EFFECTIVE DATE. This section is effective the day following final enactment.

9.1 	Sec. 10. Minnesota Statutes 2018, section 256B.0757, subdivision 5, is amended to read:
9.2 		Subd. 5.Payments. (a) The commissioner shall make payments to each designated 
9.3 	provider for the provision of health home services described in subdivision 3 to each eligible 
9.4 	individual under subdivision 2 that selects the health home as a provider establish a single, 
9.5 	statewide reimbursement rate for behavioral health home services described in subdivisions 
9.6 	4a to 4d.
9.7 	(b) The commissioner shall establish a single, statewide reimbursement rate for medical 
9.8 	respite health home services.

9.9 	EFFECTIVE DATE. This section is effective upon federal approval. The commissioner 
9.10 	shall notify the revisor of statutes when federal approval has been obtained.

9.11 	Sec. 11. Minnesota Statutes 2018, section 256B.0757, subdivision 8, is amended to read:
9.12 		Subd. 8.Evaluation and continued development. (a) For continued certification under 
9.13 	this section, behavioral health homes and medical respite health homes must meet process, 
9.14 	outcome, and quality standards developed and specified by the commissioner. The 
9.15 	commissioner shall collect data from health homes as necessary to monitor compliance with 
9.16 	certification standards.
9.17 	(b) The commissioner may contract with a private entity to evaluate patient and family 
9.18 	experiences, health care utilization, and costs.
9.19 	(c) The commissioner shall utilize findings from the implementation of behavioral health 
9.20 	homes to determine populations to serve under subsequent health home models for individuals 
9.21 	with chronic conditions.

9.22 	EFFECTIVE DATE. This section is effective the day following final enactment.

9.23 	Sec. 12. REQUIREMENTS, STANDARDS, AND QUALIFICATIONS FOR 
9.24 	MEDICAL RESPITE HEALTH HOMES.
 9.25 	The commissioner of human services, in consultation with stakeholders, shall develop 
9.26 	requirements, service standards, and qualifications for medical respite health homes.

9.27 	EFFECTIVE DATE. This section is effective the day following final enactment.

9.28 	Sec. 13. APPROPRIATION.
 9.29 	$....... in fiscal year 2020 and $....... in fiscal year 2021 are appropriated from the general 
9.30 	fund to the commissioner of human services for grants to providers of medical respite health 
10.1 	home services. Grants may be used by providers to pay for the cost of medical respite health 
10.2 	home services delivered during the period in which the medical assistance benefit is being 
10.3 	developed and federal approval is being sought. Grants shall be awarded to organizations 
10.4 	delivering medical respite services, as of January 1, 2019, to individuals experiencing 
10.5 	homelessness. Grantees must agree to work toward becoming certified as a medical respite 
10.6 	health home. This is a onetime appropriation and is available until expended.