HF 616

1st Engrossment - 91st Legislature (2019 - 2020) Posted on 03/28/2019 03:39pm

A bill for an act
relating to human services; modifying provisions governing mental health; requiring
reports; appropriating money; amending Minnesota Statutes 2018, sections
245.4889, subdivision 1; 256.478; 256B.0915, subdivision 3b; 256B.092,
subdivision 13; 256B.49, subdivision 24.

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

Section 1.

Minnesota Statutes 2018, section 245.4889, subdivision 1, is amended to read:

Subdivision 1.

Establishment and authority.

(a) The commissioner is authorized to
make grants from available appropriations to assist:

(1) counties;

(2) Indian tribes;

(3) children's collaboratives under section 124D.23 or 245.493; or

(4) mental health service providers.

(b) The following services are eligible for grants under this section:

(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;

(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;

(3) respite care services for children with severe emotional disturbances who are at risk
of out-of-home placement;

(4) children's mental health crisis services;

(5) mental health services for people from cultural and ethnic minorities;

(6) children's mental health screening and follow-up diagnostic assessment and treatment;

(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;

(8) school-linked mental health services, including transportation for children receiving
school-linked mental health services when school is not in session;

(9) building evidence-based mental health intervention capacity for children birth to age
five;

(10) suicide prevention and counseling services that use text messaging statewide;

(11) mental health first aid training;

(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;

(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;

(14) early childhood mental health consultation;

(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;

(16) psychiatric consultation for primary care practitioners; deleted text begin and
deleted text end

(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grants deleted text begin . deleted text end new text begin ; and
new text end

new text begin (18) evidence-based interventions for youth at risk of developing or experiencing a first
episode of a mood disorder and a public awareness campaign on the signs and symptoms
of mood disorders.
new text end

(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.

Sec. 2.

Minnesota Statutes 2018, section 256.478, is amended to read:

256.478 deleted text begin HOME AND COMMUNITY-BASED SERVICES TRANSITIONS
GRANTS deleted text end new text begin TRANSITION TO COMMUNITY INITIATIVE new text end .

new text begin Subdivision 1. new text end

new text begin Eligibility. new text end

new text begin (a) An individual is eligible for the transition to community
initiative if the individual meets the following criteria:
new text end

new text begin (1) without the additional resources available through the transitions to community
initiative, the individual would otherwise remain at the Anoka-Metro Regional Treatment
Center, a state-operated community behavioral health hospital, or the Minnesota Security
Hospital;
new text end

new text begin (2) the individual's discharge would be significantly delayed without the additional
resources available through the transitions to community initiative; and
new text end

new text begin (3) the individual met treatment objectives and no longer needs hospital-level care or a
secure treatment setting.
new text end

new text begin (b) An individual who is in a community hospital and on the waiting list for the
Anoka-Metro Regional Treatment Center, but for whom alternative community placement
would be appropriate is eligible for the transition to community initiative upon the
commissioner's approval.
new text end

new text begin Subd. 2. new text end

new text begin Transition grants. new text end

The commissioner shall make available deleted text begin home and
community-based services deleted text end transition new text begin to community new text end grants to deleted text begin serve deleted text end new text begin assist new text end individuals who
deleted text begin do not meet eligibility criteria for the medical assistance program under section 256B.056
or 256B.057, but who otherwise meet the criteria under section 256B.092, subdivision 13,
or 256B.49, subdivision 24 deleted text end new text begin met the criteria under subdivision 1 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.0915, subdivision 3b, is amended to read:

Subd. 3b.

Cost limits for elderly waiver applicants who reside in a nursing facility
new text begin or another eligible facility new text end .

(a) For a person who is a nursing facility resident at the time
of requesting a determination of eligibility for elderly waivered services, a monthly
conversion budget limit for the cost of elderly waivered services may be requested. The
monthly conversion budget limit for the cost of elderly waiver services shall be deleted text begin the resident
class assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident in
the nursing facility where the resident currently resides until July 1 of the state fiscal year
in which the resident assessment system as described in section 256B.438 for nursing home
rate determination is implemented. Effective on July 1 of the state fiscal year in which the
resident assessment system as described in section 256B.438 for nursing home rate
determination is implemented, the monthly conversion budget limit for the cost of elderly
waiver services shall be deleted text end based on the per diem nursing facility rate as determined by the
resident assessment system as described in section deleted text begin 256B.438 deleted text end new text begin 256R.17 new text end for residents in the
nursing facility where the elderly waiver applicant currently resides. The monthly conversion
budget limit shall be calculated by multiplying the per diem by 365, divided by 12, and
reduced by the recipient's maintenance needs allowance as described in subdivision 1d. The
initially approved monthly conversion budget limit shall be adjusted annually as described
in subdivision 3a, paragraph (a). The limit under this deleted text begin subdivision deleted text end new text begin paragraph new text end only applies to
persons discharged from a nursing facility after a minimum 30-day stay and found eligible
for waivered services on or after July 1, 1997. For conversions from the nursing home to
the elderly waiver with consumer directed community support services, the nursing facility
per diem used to calculate the monthly conversion budget limit must be reduced by a
percentage equal to the percentage difference between the consumer directed services budget
limit that would be assigned according to the federally approved waiver plan and the
corresponding community case mix cap, but not to exceed 50 percent.

(b) new text begin A person who meets elderly waiver eligibility criteria and the eligibility criteria under
section 256.478, subdivision 1, is eligible for a special monthly budget limit for the cost of
elderly waivered services up to $21,610 per month. The special monthly budget limit shall
be adjusted annually as described in subdivision 3a, paragraphs (a) and (e). For persons
using a special monthly budget limit under the elderly waiver with consumer-directed
community support services, the special monthly budget limit must be reduced as described
in paragraph (a).
new text end

new text begin (c) The commissioner may provide an additional payment for documented costs between
a threshold determined by the commissioner and the special monthly budget limit to a
managed care plan for elderly waiver services provided to a person who is:
new text end

new text begin (1) eligible for a special monthly budget limit under paragraph (b); and
new text end

new text begin (2) enrolled in a managed care plan that provides elderly waiver services under section
256B.69.
new text end

new text begin (d) For monthly conversion budget limits under paragraph (a) and special monthly budget
limits under paragraph (b), the service rate limits for adult foster care under subdivision 3d
and for customized living services under subdivision 3e may be exceeded if necessary for
the provider to meet identified needs and provide services as approved in the coordinated
service and support plan, providing that the total cost of all services does not exceed the
monthly conversion or special monthly budget limit. Service rates shall be established using
tools provided by the commissioner.
new text end

new text begin (e) new text end The following costs must be included in determining the total monthly costs for the
waiver client:

(1) cost of all waivered services, including specialized supplies and equipment and
environmental accessibility adaptations; and

(2) cost of skilled nursing, home health aide, and personal care services reimbursable
by medical assistance.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes once federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2018, section 256B.092, subdivision 13, is amended to read:

Subd. 13.

Waiver allocations for transition populations.

(a) The commissioner shall
make available additional waiver allocations and additional necessary resources deleted text begin to assure
timely discharges from the Anoka-Metro Regional Treatment Center and the Minnesota
Security Hospital in St. Peter deleted text end for individuals who meet the deleted text begin following deleted text end new text begin eligibility new text end criteria deleted text begin : deleted text end new text begin
established under section 256.478, subdivision 1.
new text end

deleted text begin (1) are otherwise eligible for the developmental disabilities waiver under this section;
deleted text end

deleted text begin (2) who would otherwise remain at the Anoka-Metro Regional Treatment Center or the
Minnesota Security Hospital;
deleted text end

deleted text begin (3) whose discharge would be significantly delayed without the available waiver
allocation; and
deleted text end

deleted text begin (4) who have met treatment objectives and no longer meet hospital level of care.
deleted text end

(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.

(c) Any corporate foster care home developed under this subdivision must be considered
an exception under section 245A.03, subdivision 7, paragraph (a).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 5.

Minnesota Statutes 2018, section 256B.49, subdivision 24, is amended to read:

Subd. 24.

Waiver allocations for transition populations.

(a) The commissioner shall
make available additional waiver allocations and additional necessary resources deleted text begin to assure
timely discharges from the Anoka-Metro Regional Treatment Center and the Minnesota
Security Hospital in St. Peter deleted text end for individuals who meet the deleted text begin following deleted text end new text begin eligibility new text end criteria deleted text begin : deleted text end new text begin
established under section 256.478, subdivision 1.
new text end

deleted text begin (1) are otherwise eligible for the brain injury, community access for disability inclusion,
or community alternative care waivers under this section;
deleted text end

deleted text begin (2) who would otherwise remain at the Anoka-Metro Regional Treatment Center or the
Minnesota Security Hospital;
deleted text end

deleted text begin (3) whose discharge would be significantly delayed without the available waiver
allocation; and
deleted text end

deleted text begin (4) who have met treatment objectives and no longer meet hospital level of care.
deleted text end

(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.

(c) Any corporate foster care home developed under this subdivision must be considered
an exception under section 245A.03, subdivision 7, paragraph (a).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 6. new text begin RATE-SETTING PROPOSAL; MENTAL HEALTH SERVICES.
new text end

new text begin The commissioner of human services shall develop a comprehensive rate-setting proposal,
compliant with federal criteria, for mental health outpatient, physician, and professional
services that do not have a cost-based, federally mandated, or contracted rate. The proposal
must include recommendations for changes to: (1) the existing fee schedule that utilizes the
Resource-Based Relative Value System (RBRVS); and (2) alternate payment methodologies
for services that do not have relative values, in order to simplify the medical assistance
fee-for-service rate structure and improve consistency and transparency in payment. The
proposal must also include recommendations for adjusting payments to reflect variations
in patient population, in order to reduce incentives for health providers to avoid high-risk
patients or populations, including those with risk factors related to race, ethnicity, language,
country of origin, and sociodemographic factors. In developing the proposal, the
commissioner shall consult with key stakeholders, including but not limited to
community-based mental health, substance use disorder, and home health care providers.
The commissioner shall present the proposal to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance by February 15, 2020.
new text end

Sec. 7. new text begin DIRECTION TO THE COMMISSIONER; FLEXIBLE ASSERTIVE
COMMUNITY MODEL AND INTENSIVE NONRESIDENTIAL REHABILITATIVE
MENTAL HEALTH SERVICE STANDARDS.
new text end

new text begin The commissioner of human services, in consultation with stakeholders, shall develop
recommendations for service standards and a payment methodology to implement the
flexible assertive community treatment model in Minnesota. The commissioner shall also
make recommendations for changes to the service standards and eligibility restriction on
age for intensive nonresidential rehabilitative mental health services under Minnesota
Statutes, section 256B.0957, to improve the consistency of the service and ensure the service
effectively meets the needs of youth and adults in Minnesota. The commissioner shall report
a summary of recommendations, including any necessary statutory changes, to the chairs
and ranking minority members of the legislative committees with jurisdiction over mental
health services by February 1, 2020.
new text end

Sec. 8. new text begin APPROPRIATION; ASSERTIVE COMMUNITY TREATMENT TEAM.
new text end

new text begin $....... in fiscal year 2020 and $....... in fiscal year 2021 are appropriated from the general
fund to the commissioner of human services for adult mental health grants under Minnesota
Statutes, section 256B.0622, subdivision 12, to expand assertive community treatment and
forensic assertive community treatment services. This appropriation is added to the base.
new text end

Sec. 9. new text begin APPROPRIATION; FIRST PSYCHOTIC EPISODE.
new text end

new text begin (a) $....... in fiscal year 2020 and $....... in fiscal year 2021 are appropriated from the
general fund to the commissioner of human services for grants under Minnesota Statutes,
section 245.4889, subdivision 1, paragraph (b), clause (15). This amount is added to the
base.
new text end

new text begin (b) Money must be used to:
new text end

new text begin (1) provide intensive treatment and supports to adolescents and adults experiencing or
at risk of a first psychotic episode. Intensive treatment and support includes medication
management, psychoeducation for the individual and family, case management, employment
supports, education supports, cognitive behavioral approaches, social skills training, peer
support, crisis planning, and stress management. Projects must use all available funding
streams;
new text end

new text begin (2) conduct outreach, training, and guidance to mental health and health care
professionals, including postsecondary health clinics, on early psychosis symptoms, screening
tools, and best practices; and
new text end

new text begin (3) ensure access to first psychotic episode psychosis services under this section, including
ensuring access for individuals who live in rural areas.
new text end

new text begin (c) Money may also be used to pay for housing or travel or to address other barriers to
individuals and their families participating in first psychotic episode services.
new text end

Sec. 10. new text begin APPROPRIATION; FIRST EPISODE MOOD DISORDER PROGRAM.
new text end

new text begin (a) $....... in fiscal year 2020 and $....... in fiscal year 2021 are appropriated from the
general fund to the commissioner of human services to fund grants under Minnesota Statutes,
section 245.4889, subdivision 1, paragraph (b), clause (18). This amount is added to the
base.
new text end

new text begin (b) Money must be used to:
new text end

new text begin (1) provide intensive treatment and supports to adolescents and adults experiencing or
at risk of a first episode of a mood disorder. Intensive treatment and support includes
medication management, psychoeducation for the individual and family, case management,
employment supports, education supports, cognitive behavioral approaches, social skills
training, peer support, crisis planning, and stress management. Projects must use all available
funding streams;
new text end

new text begin (2) conduct outreach, training, and guidance to mental health and health care
professionals, including postsecondary health clinics, on early symptoms of mood disorders,
screening tools, and best practices; and
new text end

new text begin (3) ensure access to first psychotic episode mood disorder services under this section,
including ensuring access for individuals who live in rural areas.
new text end

new text begin (c) Money may also be used to pay for housing or travel or to address other barriers to
individuals and their families participating in first episode mood disorder services.
new text end