SF 1966

Introduction - 94th Legislature (2025 - 2026)

Posted on 06/06/2025 12:17 p.m.

A bill for an act
relating to human services; modifying timelines for filing medical claims after
recoupment; modifying county of financial responsibility for withdrawal
management services; imposing closure planning requirements on providers of
peer recovery supports; modifying required timelines for mental health diagnostic
assessments; amending Minnesota Statutes 2024, sections 62Q.75, subdivision 3;
254B.05, subdivisions 1, 5; proposing coding for new law in Minnesota Statutes,
chapter 256G.

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

Section 1.

Minnesota Statutes 2024, section 62Q.75, subdivision 3, is amended to read:

Subd. 3.

Claims filing.

new text begin (a) new text end Unless otherwise provided by contract, by section 16A.124,
subdivision 4a, or by federal law, the health care providers and facilities specified in
subdivision 2 must submit their charges to a health plan company or third-party administrator
within six months from the date of service or the date the health care provider knew or was
informed of the correct name and address of the responsible health plan company or
third-party administrator, whichever is later.

new text begin (b) new text end A health care provider or facility that does not make an initial submission of charges
within the six-month period new text begin in paragraph (a), the 12-month period in paragraph (c), or the
additional six-month period in paragraph (d) new text end shall not be reimbursed for the charge and may
not collect the charge from the recipient of the service or any other payer.

new text begin (c) new text end The six-month submission requirement new text begin in paragraph (a) new text end may be extended to 12
months in cases where a health care provider or facility specified in subdivision 2 has
determined and can substantiate that it has experienced a significant disruption to normal
operations that materially affects the ability to conduct business in a normal manner and to
submit claims on a timely basis.

new text begin (d) The six-month submission requirement in paragraph (a) may be extended an additional
six months if a health plan company or third-party administrator makes any adjustment or
recoupment of payment. The additional six months begins on the date the health plan
company or third-party administrator adjusts or recoups the payment.
new text end

new text begin (e) new text end Any request by a health care provider or facility specified in subdivision 2 for an
exception to a contractually defined claims submission timeline must be reviewed and acted
upon by the health plan company within the same time frame as the contractually agreed
upon claims filing timeline.

new text begin (f) new text end This subdivision also applies to all health care providers and facilities that submit
charges to workers' compensation payers for treatment of a workers' compensation injury
compensable under chapter 176, or to reparation obligors for treatment of an injury
compensable under chapter 65B.

Sec. 2.

Minnesota Statutes 2024, section 254B.05, subdivision 1, is amended to read:

Subdivision 1.

Licensure or certification required.

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

(b) A licensed professional in private practice as defined in section 245G.01, subdivision
17, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible
vendor of a comprehensive assessment provided according to section 254A.19, subdivision
3, and treatment services provided according to sections 245G.06 and 245G.07, subdivision
1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses (1) to (6).

(c) A county is an eligible vendor for a comprehensive assessment when provided by
an individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 5,
and completed according to the requirements of section 254A.19, subdivision 3. A county
is an eligible vendor of care coordination services when provided by an individual who
meets the staffing credentials of section 245G.11, subdivisions 1 and 7, and provided
according to the requirements of section 245G.07, subdivision 1, paragraph (a), clause (5).
A county is an eligible vendor of peer recovery services when the services are provided by
an individual who meets the requirements of section 245G.11, subdivision 8.

(d) A recovery community organization that meets the requirements of clauses (1) to
(14) and meets certification or accreditation requirements of the Alliance for Recovery
Centered Organizations, the Council on Accreditation of Peer Recovery Support Services,
or a Minnesota statewide recovery organization identified by the commissioner is an eligible
vendor of peer recovery support services. A Minnesota statewide recovery organization
identified by the commissioner must update recovery community organization applicants
for certification or accreditation on the status of the application within 45 days of receipt.
If the approved statewide recovery organization denies an application, it must provide a
written explanation for the denial to the recovery community organization. Eligible vendors
under this paragraph must:

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

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

(3) have a mission statement and conduct corresponding activities indicating that the
organization's primary purpose is to support recovery from substance use disorder;

(4) demonstrate ongoing community engagement with the identified primary region and
population served by the organization, including individuals in recovery and their families,
friends, and recovery allies;

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

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

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

(8) maintain organizational practices to meet the needs of Black, Indigenous, and people
of color communities, LGBTQ+ communities, and other underrepresented or marginalized
communities. Organizational practices may include board and staff training, service offerings,
advocacy efforts, and culturally informed outreach and services;

(9) use recovery-friendly language in all media and written materials that is supportive
of and promotes recovery across diverse geographical and cultural contexts and reduces
stigma;

(10) establish and maintain a publicly available recovery community organization code
of ethics and grievance policy and procedures;

(11) not classify or treat any recovery peer hired on or after July 1, 2024, as an
independent contractor;

(12) not classify or treat any recovery peer as an independent contractor on or after
January 1, 2025;

(13) provide an orientation for recovery peers that includes an overview of the consumer
advocacy services provided by the Ombudsman for Mental Health and Developmental
Disabilities and other relevant advocacy services; deleted text begin and
deleted text end

(14) provide notice to peer recovery support services participants that includes the
following statement: "If you have a complaint about the provider or the person providing
your peer recovery support services, you may contact the Minnesota Alliance of Recovery
Community Organizations. You may also contact the Office of Ombudsman for Mental
Health and Developmental Disabilities." The statement must also include:

(i) the telephone number, website address, email address, and mailing address of the
Minnesota Alliance of Recovery Community Organizations and the Office of Ombudsman
for Mental Health and Developmental Disabilities;

(ii) the recovery community organization's name, address, email, telephone number, and
name or title of the person at the recovery community organization to whom problems or
complaints may be directed; and

(iii) a statement that the recovery community organization will not retaliate against a
peer recovery support services participant because of a complaint new text begin ; and
new text end

new text begin (15) comply with the requirements of section 245A.04, subdivision 15a new text end .

(e) A recovery community organization approved by the commissioner before June 30,
2023, must have begun the application process as required by an approved certifying or
accrediting entity and have begun the process to meet the requirements under paragraph (d)
by September 1, 2024, in order to be considered as an eligible vendor of peer recovery
support services.

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

(g) All recovery community organizations must be certified or accredited by an entity
listed in paragraph (d) by June 30, 2025.

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

(i) Hospitals, federally qualified health centers, and rural health clinics are eligible
vendors of a comprehensive assessment when the comprehensive assessment is completed
according to section 254A.19, subdivision 3, and by an individual who meets the criteria
of an alcohol and drug counselor according to section 245G.11, subdivision 5. The alcohol
and drug counselor must be individually enrolled with the commissioner and reported on
the claim as the individual who provided the service.

(j) Any complaints about a recovery community organization or peer recovery support
services may be made to and reviewed or investigated by the ombudsperson for behavioral
health and developmental disabilities under sections 245.91 and 245.94.

Sec. 3.

Minnesota Statutes 2024, section 254B.05, subdivision 5, is amended to read:

Subd. 5.

Rate requirements.

(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.

(b) Eligible substance use disorder treatment services include:

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

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

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

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

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

(v) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5). The commissioner shall use the
base payment rate of $79.84 per day for services provided under this item;

(vi) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5), at 15 or more hours of skilled
treatment services each week. The commissioner shall use the base payment rate of $166.13
per day for services provided under this item;

(vii) ASAM level 3.3 clinically managed population-specific high-intensity residential
services provided according to section 254B.19, subdivision 1, clause (6). The commissioner
shall use the specified base payment rate of $224.06 per day for services provided under
this item; and

(viii) ASAM level 3.5 clinically managed high-intensity residential services provided
according to section 254B.19, subdivision 1, clause (7). The commissioner shall use the
specified base payment rate of $224.06 per day for services provided under this item;

(2) comprehensive assessments provided according to section 254A.19, subdivision 3;

(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) substance use disorder treatment services with medications for opioid use disorder
provided in an opioid treatment program licensed according to sections 245G.01 to 245G.17
and 245G.22, or under an applicable Tribal license;

(8) medium-intensity residential treatment services that provide 15 hours of skilled
treatment services each week and are licensed according to sections 245G.01 to 245G.17
and 245G.21 or applicable Tribal license;

(9) 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;

(10) 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

(11) room and board facilities that meet the requirements of subdivision 1a.

(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:

(1) programs that serve parents with their children if the program:

(i) provides on-site child care during the hours of treatment activity that:

(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or

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

(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:

(A) a child care center under Minnesota Rules, chapter 9503; or

(B) a family child care home under Minnesota Rules, chapter 9502;

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

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

(4) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to one hour 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) the program employs a mental health professional as defined in section 245I.04,
subdivision 2;

(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission new text begin , excluding weekends and holidays new text end ;

(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;

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

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

(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the substance use disorder facility of the child care provider's current licensure to provide
child care services.

(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (5), items (i) to (iv).

(f) Substance use disorder services that are otherwise covered as direct face-to-face
services may be provided via telehealth as defined in section 256B.0625, subdivision 3b.
The use of telehealth to deliver services must be medically appropriate to the condition and
needs of the person being served. Reimbursement shall be at the same rates and under the
same conditions that would otherwise apply to direct face-to-face services.

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

(h) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.

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

(j) A license holder that is unable to provide all residential treatment services because
a client missed services remains eligible to bill for the client's intensity level of services
under this paragraph if the license holder can document the reason the client missed services
and the interventions done to address the client's absence.

(k) Hours in a treatment week may be reduced in observance of federally recognized
holidays.

(l) Eligible vendors of peer recovery support services must:

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

(2) limit an individual client to 14 hours per week for peer recovery support services
from an individual provider of peer recovery support services.

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

Sec. 4.

new text begin [256G.061] WITHDRAWAL MANAGEMENT SERVICES.
new text end

new text begin The county of financial responsibility for withdrawal management services is defined
in section 256G.02, subdivision 4.
new text end