SF 4820
Introduction - 94th Legislature (2025 - 2026)
Posted on 03/26/2026 09:20 a.m.
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A bill for an act
relating to medical assistance; modifying certified community behavioral health
clinic rates and rebasing schedules; amending Minnesota Statutes 2025 Supplement,
section 256B.0625, subdivision 5m.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2025 Supplement, section 256B.0625, subdivision 5m, is
amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers services provided by a not-for-profit certified community behavioral health
clinic (CCBHC) that meets the requirements of section 245.735, subdivision 3.
(b) The commissioner shall reimburse CCBHCs on a per-day basis for each day that an
eligible service is delivered using the CCBHC daily bundled rate system for medical
assistance payments as described in paragraph (c). The commissioner shall include a quality
incentive payment in the CCBHC daily bundled rate system as described in paragraph (e).
There is no county share for medical assistance services when reimbursed through the
CCBHC daily bundled rate system.
(c) The commissioner shall ensure that the CCBHC daily bundled rate system for CCBHC
payments under medical assistance meets the following requirements:
(1) the CCBHC daily bundled rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
CCBHC costs divided by the total annual number of CCBHC visits. For calculating the
payment rate, total annual visits include visits covered by medical assistance and visits not
covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
(2) payment shall be limited to one payment per day per medical assistance enrollee
when an eligible CCBHC service is provided. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
(3) initial CCBHC daily bundled rates for newly certified CCBHCs under section 245.735,
subdivision 3, shall be established by the commissioner using a provider-specific rate based
on the newly certified CCBHC's audited historical cost report data adjusted for the expected
cost of delivering CCBHC services. Estimates are subject to review by the commissioner
and must include the expected cost of providing the full scope of CCBHC services and the
expected number of visits for the rate period;
(4) the commissioner shall rebase CCBHC rates once every two years following the last
rebasing and no less than 12 months following an initial rate or a rate change due to a change
in the scope of services. For CCBHCs certified after September 30, 2020, and before January
1, 2021, the commissioner shall rebase rates according to this clause for services provided
on or after January 1, 2024new text begin . For CCBHCs certified after .... and before ...., notwithstanding
the requirement to rebase rates once every two years following the last rebasing, the
commissioner shall:
new text end
new text begin
(i) apply the rate for services provided for calendar year 2023, updated in accordance
with clause (8), for services provided through December 31, 2026; and
new text end
new text begin (ii) rebase rates according to this clause for services provided on or after January 1,
2027new text end ;
(5) the commissioner shall provide for a 60-day appeals process after notice of the results
of the rebasing;
(6) an entity that receives a CCBHC daily bundled rate that overlaps with another federal
Medicaid rate is not eligible for the CCBHC rate methodology;
(7) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments. The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the CCBHC daily bundled rate system in the Medicaid Management Information System
(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments
due made payable to CCBHCs no later than 18 months thereafter;
(8) the CCBHC daily bundled rate for each CCBHC shall be updated by trending each
provider-specific rate by the Medicare Economic Index for primary care services. This
update shall occur each year in between rebasing periods determined by the commissioner
in accordance with clause (4). CCBHCs must provide data on costs and visits to the state
annually using the CCBHC cost report established by the commissioner; and
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. Estimated costs are subject to review by the commissioner. Rate
adjustments for changes in scope shall occur no more than once per year in between rebasing
periods per CCBHC and are effective on the date of the annual CCBHC rate update.
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the CCBHC daily bundled rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. 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 deleted text begin provisiondeleted text end new text begin paragraphnew text end . 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 deleted text begin provisiondeleted text end new text begin paragraphnew text end . This
paragraph expires if federal approval is not received for this paragraph at any time.
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the CCBHC daily bundled rate system described in
paragraph (c);
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
(g) Peer services provided by a CCBHC certified under section 245.735 are a covered
service under medical assistance when a licensed mental health professional or alcohol and
drug counselor determines that peer services are medically necessary. Eligibility under this
subdivision for peer services provided by a CCBHC supersede eligibility standards under
sections 256B.0615, 256B.0616, and 245G.07, subdivision 2a, paragraph (b), clause (2).