HF 358

1st Engrossment - 88th Legislature (2013 - 2014) Posted on 02/25/2013 03:47pm

A bill for an act
relating to human services; requiring an electronic survey of providers of
pediatric services and children's mental health services; establishing new mental
health services covered under medical assistance; amending Minnesota Statutes
2012, sections 256B.02, subdivision 12; 256B.0625, subdivision 56, by adding
subdivisions; 256B.0943, subdivisions 1, 2; proposing coding for new law in
Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2012, section 256B.02, subdivision 12, is amended to
read:

Subd. 12.

Third-party payer.

"Third-party payer" means a person, entity, or agency
or government program that has a probable obligation to pay all or part of the costs of a
medical assistance recipient's health services. Third-party payer includes an entity under
contract with the recipient to cover all or part of the recipient's medical costs. new text begin Third-party
payer does not include a school district for costs for clinical mental health care.
new text end

Sec. 2.

new text begin [256B.0616] MENTAL HEALTH CERTIFIED FAMILY PEER
SPECIALIST.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin Medical assistance covers mental health certified family peer
specialists services, as established in subdivision 2, subject to federal approval, if provided
to recipients who have an emotional disturbance or severe emotional disturbance under
chapter 245, and are provided by a certified family peer specialist who has completed the
training under subdivision 5. A family peer specialist cannot provide services to the
peer specialist's family.
new text end

new text begin Subd. 2. new text end

new text begin Establishment. new text end

new text begin The commissioner of human services shall establish a
certified family peer specialists program model which:
new text end

new text begin (1) provides nonclinical family peer support counseling, building on the strengths
of families and helping them achieve desired outcomes;
new text end

new text begin (2) collaborates with others providing care or support to the family;
new text end

new text begin (3) provides nonadversarial advocacy;
new text end

new text begin (4) promotes the individual family culture in the treatment milieu;
new text end

new text begin (5) links parents to other parents in the community;
new text end

new text begin (6) offers support and encouragement;
new text end

new text begin (7) assists parents in developing coping mechanisms and problem-solving skills;
new text end

new text begin (8) promotes resiliency, self-advocacy, development of natural supports, and
maintenance of skills learned in other support services;
new text end

new text begin (9) establishes and provides peer led parent support groups; and
new text end

new text begin (10) increases the child's ability to function better within the child's home, school,
and community by educating parents on community resources, assisting with problem
solving, and educating parents on mental illnesses.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin Family peer specialist services may be located in inpatient
hospitalization, partial hospitalization, residential treatment, treatment foster care, day
treatment, children's therapeutic services and supports, or crisis services.
new text end

new text begin Subd. 4. new text end

new text begin Peer specialist program providers. new text end

new text begin The commissioner shall develop
a process to certify family peer specialist programs, in accordance with the federal
guidelines, in order for the program to bill for reimbursable services. Family peer specialist
programs must operate within an existing mental health community provider or center.
new text end

new text begin Subd. 5. new text end

new text begin Certified family peer specialist training and certification. new text end

new text begin The
commissioner shall develop a training and certification process for certified family peer
specialists who must be at least 21 years of age and have a high school diploma or its
equivalent. The candidates must have raised or are currently raising a child with a mental
illness, have had experience navigating the children's mental health system, and must
demonstrate leadership and advocacy skills and a strong dedication to family-driven and
family-focused services. The training curriculum must teach participating family peer
specialists specific skills relevant to providing peer support to other parents. In addition
to initial training and certification, the commissioner shall develop ongoing continuing
educational workshops on pertinent issues related to family peer specialist services.
new text end

Sec. 3.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 35c. new text end

new text begin School-based mental health services. new text end

new text begin Medical assistance covers
mental health services provided in a school by an individual licensed as a professional
counselor under sections 148B.50 to 148B.593 when the licensed professional counselor
is supervised by a licensed mental health professional.
new text end

Sec. 4.

Minnesota Statutes 2012, section 256B.0625, subdivision 56, is amended to read:

Subd. 56.

Medical service coordination.

(a) new text begin (1) new text end Medical assistance covers in-reach
community-based service coordination that is performed through a hospital emergency
department as an eligible procedure under a state healthcare program for a frequent user.
A frequent user is defined as an individual who has frequented the hospital emergency
department for services three or more times in the previous four consecutive months.
In-reach community-based service coordination includes navigating services to address a
client's mental health, chemical health, social, economic, and housing needs, or any other
activity targeted at reducing the incidence of emergency room and other nonmedically
necessary health care utilization.

new text begin (2) Medical assistance also covers in-reach community-based service coordination
that is performed through a hospital emergency department or inpatient psychiatric unit,
residential treatment center, community mental health center, children's therapeutic
services and supports provider, or juvenile justice facility as an eligible provider under a
state health care program for a child with a serious emotional disturbance and for young
adults up to age 26.
new text end

(b) Reimbursement must be made in 15-minute increments and allowed for up to
60 days posthospital discharge based upon the specific identified emergency department
visit or inpatient admitting event. In-reach community-based service coordination
shall seek to connect frequent users with existing covered services available to them,
including, but not limited to, targeted case management, waiver case management, or care
coordination in a health care home. new text begin For children with a serious emotional disturbance,
in-reach community-based service coordination shall seek to connect them with existing
covered services, including targeted case management, waiver case management, care
coordination in a health care home, children's therapeutic services and supports, crisis
services, and respite care. new text end Eligible in-reach service coordinators must hold a minimum
of a bachelor's degree in social work, public health, corrections, or a related field. The
commissioner shall submit any necessary application for waivers to the Centers for
Medicare and Medicaid Services to implement this subdivision.

(c) For the purposes of this subdivision, "in-reach community-based service
coordination" means the practice of a community-based worker with training, knowledge,
skills, and ability to access a continuum of services, including housing, transportation,
chemical and mental health treatment, employment, new text begin education, new text end and peer support services,
by working with an organization's staff to transition an individual back into the individual's
living environment. In-reach community-based service coordination includes working
with the individual during their discharge and for up to a defined amount of time in the
individual's living environment, reducing the individual's need for readmittance.

Sec. 5.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 61. new text end

new text begin Family psychoeducation services. new text end

new text begin Effective July 1, 2013, and subject to
federal approval, medical assistance covers family psychoeducation services provided
to or on behalf of a child up to age 21 with a diagnosed mental health condition when
identified in the child's individual treatment plan and provided by a licensed mental health
professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a
clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who
has determined it medically necessary to involve family members in the child's care. For
the purposes of this subdivision, "family psychoeducation services" means information
or demonstration provided to an individual or family as part of an individual, family,
multifamily group, or peer group session to explain, educate, and support the child and
family in understanding a child's symptoms of mental illness, the impact on the child's
development, and needed components of treatment and skill development so that the
individual, family, or group can help the child to prevent relapse, prevent the acquisition
of comorbid disorders, and to achieve optimal mental health and long-term resilience.
new text end

Sec. 6.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 62. new text end

new text begin Mental health clinical care consultation. new text end

new text begin Effective July 1, 2013,
and subject to federal approval, medical assistance covers clinical care consultation for
a person up to age 21 who is diagnosed with a complex mental health condition or a
mental health condition that co-occurs with other complex and chronic conditions, when
described in the person's individual treatment plan and provided by a licensed mental
health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A. For
the purposes of this subdivision, "clinical care consultation" means communication from a
treating mental health professional to other providers not under the clinical supervision of
the treating mental health professional who are working with the same client to inform,
inquire, and instruct regarding the client's symptoms, strategies for effective engagement,
care and intervention needs, and treatment expectations across service settings; and to
direct and coordinate clinical services components provided to the client and family.
new text end

Sec. 7.

Minnesota Statutes 2012, section 256B.0943, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

For purposes of this section, the following terms have
the meanings given them.

(a) "Children's therapeutic services and supports" means the flexible package of
mental health services for children who require varying therapeutic and rehabilitative
levels of intervention. The services are time-limited interventions that are delivered using
various treatment modalities and combinations of services designed to reach treatment
outcomes identified in the individual treatment plan.

(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.

(c) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.

(e) "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A
provider may be culturally competent because the provider is of the same cultural or
ethnic group as the client or the provider has developed the knowledge and skills through
training and experience to provide services to culturally diverse clients.

(f) "Day treatment program" for children means a site-based structured program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.

(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11.

(h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling, maintaining clinical records, consulting with others
about the client's mental health status, preparing reports, receiving clinical supervision,
and revising the client's individual treatment plan.

(i) "Direction of mental health behavioral aide" means the activities of a mental
health professional or mental health practitioner in guiding the mental health behavioral
aide in providing services to a client. The direction of a mental health behavioral aide
must be based on the client's individualized treatment plan and meet the requirements in
subdivision 6, paragraph (b), clause (5).

(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15. For persons at least age 18 but under age 21, mental illness has the meaning given in
section 245.462, subdivision 20, paragraph (a).

(k) "Individual behavioral plan" means a plan of intervention, treatment, and
services for a child written by a mental health professional or mental health practitioner,
under the clinical supervision of a mental health professional, to guide the work of the
mental health behavioral aide.

(l) "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21.

(m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a trained paraprofessional to assist a child retain or generalize
psychosocial skills as taught by a mental health professional or mental health practitioner
and as described in the child's individual treatment plan and individual behavior plan.
Activities involve working directly with the child or child's family as provided in
subdivision 9, paragraph (b), clause (4).

(n) "Mental health professional" means an individual as defined in section 245.4871,
subdivision 27, clauses (1) to (6), or tribal vendor as defined in section 256B.02,
subdivision 7, paragraph (b).

(o) "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.

(p) "Skills training" means individual, family, or group training, delivered by or
under the direction of a mental health professional, designed to facilitate the acquisition
of psychosocial skills that are medically necessary to rehabilitate the child to an
age-appropriate developmental trajectory heretofore disrupted by a psychiatric illness
or to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is
subject to the following requirements:

(1) a mental health professional or a mental health practitioner must provide skills
training;

(2) the child must always be present during skills training; however, a brief absence
of the child for no more than ten percent of the session unit may be allowed to redirect or
instruct family members;

(3) skills training delivered to children or their families must be targeted to the
specific deficits or maladaptations of the child's mental health disorder and must be
prescribed in the child's individual treatment plan;

(4) skills training delivered to the child's family must teach skills needed by parents
to enhance the child's skill development and to help the child use in daily life the skills
previously taught by a mental health professional or mental health practitioner and to
develop or maintain a home environment that supports the child's progressive use skills;

(5) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:

(i) one mental health professional or one mental health practitioner under supervision
of a licensed mental health professional must work with a group of four to eight clients; or

(ii) two mental health professionals or two mental health practitioners under
supervision of a licensed mental health professional, or one professional plus one
practitioner must work with a group of nine to 12 clients.

new text begin (q) "Care coordination" means contact with other professionals, educators, and
caregivers of the client in person or by telephone to facilitate continuity and consistency in
support of the client and the treatment plan, screening to determine client suitability for
treatment, and development and updating of the treatment plan.
new text end

new text begin (r) Assessment includes the provision of commissioner-approved assessment tools
and completion of a functional assessment.
new text end

Sec. 8.

Minnesota Statutes 2012, section 256B.0943, subdivision 2, is amended to read:

Subd. 2.

Covered service components of children's therapeutic services and
supports.

(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports as defined in this section that an eligible
provider entity certified under subdivision 4 provides to a client eligible under subdivision
3.

(b) The service components of children's therapeutic services and supports are:

(1) individual, family, and group psychotherapy;

(2) individual, family, or group skills training provided by a mental health
professional or mental health practitioner;

(3) crisis assistance;

(4) mental health behavioral aide services; deleted text begin and
deleted text end

(5) direction of a mental health behavioral aide deleted text begin . deleted text end new text begin ;
new text end

new text begin (6) care coordination provided by a mental health professional or mental health
practitioner;
new text end

new text begin (7) assessment provided by a mental health professional or mental health practitioner;
new text end

new text begin (8) clinical care consultation provided by a mental health professional under section
256B.0625, subdivision 62;
new text end

new text begin (9) family psychoeducation under section 256B.0625, subdivision 61; and
new text end

new text begin (10) services provided by a certified family peer specialist under section 256B.0616.
new text end

(c) Service components in paragraph (b) may be combined to constitute therapeutic
programs, including day treatment programs and therapeutic preschool programs.

Sec. 9. new text begin PILOT PROVIDER INPUT SURVEY.
new text end

new text begin (a) To assess the efficiency and other operational issues in the management of the
health care delivery system, the commissioner of human services shall initiate a provider
survey. The pilot survey shall consist of an electronic survey of providers of pediatric
services and children's mental health services to identify and measure issues that arise in
dealing with the management of medical assistance. To the maximum degree possible
existing technology shall be used and interns sought to analyze the results.
new text end

new text begin (b) The survey questions must focus on seven key business functions provided
by medical assistance contractors: provider inquiries; provider outreach and education;
claims processing; appeals; provider enrollment; medical review; and provider audit and
reimbursement. The commissioner must consider the results of the survey in evaluating
and renewing managed care and fee-for-service management contracts.
new text end

new text begin (c) The commissioner shall report the results of the survey to the chairs of the health
and human services policy and finance committees and shall make recommendations on
the value of implementing an annual survey with a rotating list of provider groups as a
component of the continuous quality improvement system for medical assistance.
new text end