HF 919

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 04/27/2017 02:18pm

A bill for an act
relating to human services; modifying certain provisions governing autism early
intensive intervention benefit; amending Minnesota Statutes 2016, section
256B.0949.

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

Section 1.

Minnesota Statutes 2016, section 256B.0949, is amended to read:

256B.0949 AUTISM EARLY INTENSIVE DEVELOPMENTAL AND
BEHAVIORAL INTERVENTION BENEFIT.

Subdivision 1.

Purpose.

This section creates a new benefit authorizes the early intensive
developmental and behavioral intervention (EIDBI) benefit to provide early intensive
intervention to a child person with an autism spectrum disorder diagnosis or a related
condition. This benefit must provide coverage for diagnosis a comprehensive,
multidisciplinary assessment evaluation, ongoing progress evaluation monitoring, and
medically necessary early intensive treatment of autism spectrum disorder or a related
condition. Nothing in this section shall preclude coverage for other medical assistance
benefits based on a person's diagnosis of an autism spectrum disorder or a related condition,
including, but not limited to, coverage under section 256B.0943 of children's therapeutic
services and supports.

Subd. 2.

Definitions.

(a) For the purposes of this section, The terms defined used in this
subdivision section have the meanings given in this subdivision.

(b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the current
version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.

(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:

(1) is severe and chronic;

(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;

(3) requires treatment or services similar to those required for a person with ASD; and

(4) results in substantial functional limitations in three core developmental deficits of
ASD: social interaction; nonverbal or social communication; and restrictive, repetitive
behaviors or hyperreactivity or hyporeactivity to sensory input; and may include deficits or
a high level of support in one or more of the following domains:

(i) self-regulation;

(ii) self-care;

(iii) behavioral challenges;

(iv) expressive communication;

(v) receptive communication;

(vi) cognitive functioning; or

(vii) safety.

(c) (d) "Child Person" means a person under the age of 18 21 years of age.

(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.

(d) (f) "Commissioner" means the commissioner of human services, unless otherwise
specified.

(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.

(h) "Department" means the Department of Human Services, unless otherwise specified.

(e) (i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means autism treatment options a variety of individualized, intensive treatment
modalities approved by the commissioner that are based in behavioral and developmental
science, which may include modalities such as applied behavior analysis, developmental
treatment approaches, and naturalistic and parent training models consistent with best
practices on effectiveness.

(f) (j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and children people, and in different environments including, but not limited to, clinics,
homes, schools, and the community.

(k) "Incident" means when any of the following occur:

(1) an illness, accident, or injury that requires first aid treatment;

(2) a bump or blow to the head; or

(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.

(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.

(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.

(g) (n) "Mental health professional" has the meaning given in section 245.4871,
subdivision 27, clauses (1) to (6).

(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.

(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.

Subd. 3.

Initial EIDBI eligibility.

This benefit An EIDBI service is available to a child
person enrolled in medical assistance who:

(1) has an autism spectrum disorder a diagnosis of ASD or a related condition that meets
the criteria of subdivision 4; and

(2) has had a diagnostic assessment described in subdivision 5, which recommends early
intensive intervention services; and

(3) (2) meets the criteria for medically necessary autism early intensive intervention
services for the EIDBI benefit.

Subd. 3a.

Culturally and linguistically appropriate requirement.

The person's and
family's primary spoken language and culture, values, goals, and preferences must be
reflected throughout the covered services. The CMDE provider and QSP must determine
how to adapt the evaluation, treatment recommendations, and individual treatment plan to
the person's and family's culture, values, and language preferences. A provider must have
a limited English proficiency (LEP) plan in compliance with title VI of the Civil Rights Act
of 1964, United States Code, title 42, section 2000d to 2000d-7.

Subd. 4.

Diagnosis.

(a) A diagnosis of ASD or a related condition must:

(1) be based upon current DSM criteria including direct observations of the child person
and reports information from parents the person's legal representative or primary caregivers;
and

(2) be completed by either (i) a licensed physician or advanced practice registered nurse
or (ii) a mental health professional; and

(3) meet the requirements of Minnesota Rules, part 9505.0372, subpart 1, items B and
C.

(b) Additional diagnostic assessment information may be considered to complete a
diagnostic assessment including from specialized tests administered through special education
evaluations and licensed school personnel, and from professionals licensed in the fields of
medicine, speech and language, psychology, occupational therapy, and physical therapy.
A diagnostic assessment may include treatment recommendations.

Subd. 5.

Diagnostic assessment Comprehensive multidisciplinary evaluation.

The
following (a) A CMDE must be completed to determine medical necessity of EIDBI services.
For the commissioner to authorize EIDBI services, the CMDE provider must submit the
CMDE to the commissioner and the person or the person's legal representative as determined
by the commissioner. Information and assessments must be performed, reviewed, and relied
upon for the eligibility determination, treatment and services recommendations, and treatment
plan development for the child: person.

(b) The CMDE must:

(1) include an assessment of the child's person's developmental skills, functional behavior,
needs, and capacities based on direct observation of the child person which must be
administered by a licensed mental health professional CMDE provider, must include medical
or assessment information from the child's person's physician or advanced practice registered
nurse, and may also include observations input from family members, school personnel,
child care providers, or other caregivers, as well as any medical or assessment information
from other licensed professionals such as rehabilitation or habilitation therapists, licensed
school personnel, or mental health professionals; and

(2) an assessment of parental or caregiver capacity to participate in therapy including
the type and level of parental or caregiver involvement and training recommended.

(2) include and document the person's legal representative's or primary caregiver's
preferences for involvement in the person's treatment; and

(3) provide information about the range of current EIDBI treatment modalities recognized
by the commissioner.

Subd. 5a.

Comprehensive multidisciplinary evaluation provider qualification.

A
CMDE provider must:

(1) be a licensed physician, advanced practice registered nurse, a mental health
professional, or a mental health practitioner who meets the requirements of a clinical trainee
as defined in Minnesota Rules, part 9505.0371, subpart 5, item C;

(2) have at least 2,000 hours of clinical experience in the evaluation and treatment of
people with ASD or a related condition or equivalent documented coursework at the graduate
level by an accredited university in the following content areas: ASD or a related condition
diagnosis, ASD or a related condition treatment strategies, and child development; and

(3) be able to diagnose, evaluate, or provide treatment within the provider's scope of
practice and professional license.

Subd. 6.

Individual treatment plan.

(a) The QSP, level I treatment provider, or level
II treatment provider who integrates and coordinates person and family information from
the CMDE and ITP progress monitoring process to develop the ITP must develop and
monitor the ITP.

(b) Each child's treatment plan person's ITP must be:

(1) culturally and linguistically appropriate, as required under subdivision 3a,
individualized, and person-centered; and

(1) (2) based on the diagnostic assessment diagnosis and CMDE information specified
in subdivisions 4 and 5;.

(2) coordinated with medically necessary occupational, physical, and speech and language
therapies, special education, and other services the child and family are receiving;

(3) family-centered;

(4) culturally sensitive; and

(5) individualized based on the child's developmental status and the child's and family's
identified needs.

(b) (c) The treatment plan ITP must specify the:

(1) child's goals which are developmentally appropriate, functional, and generalizable;

(2) treatment modality;

(3) treatment intensity;

(4) setting; and

(5) level and type of parental or caregiver involvement.

(1) the medically necessary treatment and service;

(2) the treatment modality that shall be used to meet the goals and objectives, including:

(i) baseline measures and projected dates of accomplishment;

(ii) the frequency, intensity, location, and duration of each service provided;

(iii) the level of legal representative or primary caregiver training and counseling;

(iv) any change or modification to the physical and social environments necessary to
provide a service;

(v) significant changes in the person's condition or family circumstance;

(vi) any specialized equipment or material required;

(vii) techniques that support and are consistent with the person's communication mode
and learning style;

(viii) the name of the QSP; and

(ix) progress monitoring results and goal mastery data; and

(3) the discharge criteria that shall be used and a defined transition plan that meets the
requirement of paragraph (g).

(c) (d) Implementation of the treatment ITP must be supervised by a professional with
expertise and training in autism and child development who is a licensed physician, advanced
practice registered nurse, or mental health professional QSP.

(d) (e) The treatment plan ITP must be submitted to the commissioner and the person
or the person's legal representative for approval in a manner determined by the commissioner
for this purpose.

(e) Services authorized must be consistent with the child's approved treatment plan.

(f) Services A service included in the treatment plan ITP must meet all applicable
requirements for medical necessity and coverage.

(g) To terminate service, the provider must send notice of termination to the person or
the person's legal representative. The transition period begins when the person or the person's
legal representative receives notice of termination from the EIDBI service and ends when
the EIDBI service is terminated. Up to 30 days of continued service is allowed during the
transition period. Services during the transition period shall be consistent with the ITP. The
transition plan shall include:

(1) protocols for changing service when medically necessary;

(2) how the transition will occur;

(3) the time allowed to make the transition; and

(4) a description of how the person or the person's legal representative will be informed
of and involved in the transition.

Subd. 7.

Ongoing eligibility Individual treatment plan progress monitoring.

(a) An
independent ITP progress evaluation conducted by a licensed mental health professional
with expertise and training in autism spectrum disorder and child development monitoring
must be completed submitted after each six months of treatment, or more frequently as
determined by the commissioner CMDE provider or QSP, to determine if progress is being
made toward achieving targeted functional and generalizable goals and meeting functional
goals contained specified in the treatment plan ITP. Based on the results of ITP progress
monitoring, the ITP must be adjusted as needed and must document that the EIDBI service
continues to be medically necessary for the person or the person is referred to other services.

(b) The ITP progress evaluation monitoring must include:

(1) the treating provider's report;

(2) parental or caregiver (1) input from the person's legal representative or the person's
primary caregiver;

(3) (2) an independent observation of the child which can be person that is performed
by the child's the QSP, level I treatment provider, or level II treatment provider and may
include input from licensed special education staff or other licensed health care provider;

(3) documentation of the person's current level of performance on primary treatment
goal domains including when a goal or objective is achieved, changed, or discontinued;

(4) any significant change in the person's condition or family circumstances;

(4) (5) any treatment plan modifications modification and the rationale for any change
made, including treatment modality, intensity, frequency, and duration; and

(5) (6) recommendations for continued treatment services.

(c) The ITP progress evaluations monitoring must be submitted to the commissioner in
a manner and the person or the person's legal representative in a manner determined by the
commissioner for this purpose the reauthorization of EIDBI services.

(d) A child person who continues to achieve generalizable goals and make reasonable
progress toward treatment goals as specified in the treatment plan ITP is eligible to continue
receiving this benefit EIDBI services.

(e) A child's person's treatment shall continue during the ITP progress evaluation
monitoring using the process determined under subdivision 8, clause (8) this subdivision.
Treatment may continue during an appeal pursuant to section 256.045.

Subd. 8.

Refining the benefit with stakeholders.

The commissioner must develop the
implementation refine the details of the benefit in consultation with stakeholders and consider
recommendations from the Health Services Advisory Council, the Department of Human
Services Autism Spectrum Disorder Early Intensive Developmental and Behavioral
Intervention Advisory Council, the Legislative Autism Spectrum Disorder Task Force early
intensive developmental and behavioral intervention learning collaborative, and the
Interagency Task Force of the Departments of Health, Education, Employment and Economic
Development, and Human Services. The commissioner must release these details for a
30-day public comment period prior to submission to the federal government for approval.
The implementation details must include, but are not limited to, the following components:

(1) a definition of the qualifications, standards, and roles of the treatment team, including
recommendations after stakeholder consultation on whether board-certified behavior analysts
and other types of professionals certified in other treatment approaches recognized by the
department or trained in autism spectrum disorder ASD or a related condition and child
development should be added as mental health or other professionals for treatment qualified
to provide EIDBI clinical supervision or other functions under medical assistance;

(2) development of initial, refinement of uniform parameters for comprehensive
multidisciplinary diagnostic assessment information CMDE and progress evaluation ongoing
ITP progress monitoring standards;

(3) the design of an effective and consistent process for assessing parent the person's
and the person's legal representative's and caregiver capacity the person's caregiver's
preferences and options to participate in the child's person's early intervention treatment
and efficacy of methods of involving the parents to involve and educate the person's legal
representative and caregivers caregiver in the treatment of the child person;

(4) formulation of a collaborative process in which professionals have opportunities to
collectively inform a comprehensive, multidisciplinary diagnostic assessment provider
standards and qualifications; standards for CMDE; medical necessity determination; efficacy
of treatment apparatus, including modality, intensity, frequency, and duration; and progress
evaluation ITP progress monitoring processes and standards to support quality improvement
of early intensive intervention EIDBI services;

(5) coordination of this benefit and its interaction with other services provided by the
Departments of Human Services, Health, Employment and Economic Development, and
Education;

(6) evaluation, on an ongoing basis, of research regarding the program EIDBI services
outcomes and efficacy of treatment modalities provided to children people under this benefit;
and

(7) as provided under subdivision 17, determination of the availability of licensed
physicians, nurse practitioners, and mental health professionals qualified EIDBI providers
with necessary expertise and training in autism spectrum disorder ASD or a related condition
throughout the state to assess whether there are sufficient professionals to require involvement
of both a physician or nurse practitioner and a mental health professional to provide timely
access and prevent delay in the diagnosis CMDE and treatment of young children, so as to
implement subdivision 4, and to ensure treatment is effective, timely, and accessible; and
a person with ASD or a related condition.

(8) development of the process for the progress evaluation that will be used to determine
the ongoing eligibility, including necessary documentation, timelines, and responsibilities
of all parties.

Subd. 9.

Revision of treatment options.

(a) The commissioner may revise covered
treatment options as needed based on outcome data and other evidence. EIDBI treatment
modalities approved by the department must:

(1) cause no harm to the person or the person's family;

(2) be individualized and person-centered;

(3) be developmentally appropriate and highly structured, with well-defined goals and
objectives that provide a strategic direction for treatment;

(4) be based in recognized principles of developmental and behavioral science;

(5) utilize sound practices that are replicable across providers and maintain the fidelity
of the specific modality;

(6) demonstrate an evidentiary basis;

(7) have goals and objectives that are measurable, achievable, and be regularly evaluated
and adjusted to ensure that adequate progress is being made;

(8) be provided intensively with a high staff-to-person ratio; and

(9) include participation by the person and the person's legal representative in decision
making, knowledge building and capacity building, and developing and implementing the
person's ITP.

(b) Before the changes revisions in department recognized treatment modalities become
effective, the commissioner must provide public notice of the changes, the reasons for the
change, and a 30-day public comment period to those who request notice through an
electronic list accessible to the public on the department's Web site.

Subd. 10.

Coordination between agencies and other benefits.

(a) The commissioners
of human services and education must develop the capacity to coordinate services and
information including diagnostic, functional, developmental, medical, and educational
assessments; service delivery; and progress evaluations across health and education sectors.

(b) An EIDBI service provided under this section is not intended to replace a service
provided in school or other settings. A person's ITP must document that EIDBI services
coordinate with, but do not include or replace, special education and related services defined
in the person's individualized education plan (IEP), or individualized family service plan
(IFSP), when the service is available under the Individuals with Disabilities Education
Improvement Act of 2004, United States Code, title 20, chapter 33, through a local education
agency. This provision does not preclude EIDBI treatment during school hours. A program
for birth to three years of age and additional resources must also coordinate with EIDBI
services. A resource for a person over 18 years of age must also be coordinated with EIDBI
services under this section.

(c) The commissioner shall integrate medical authorization procedures for an EIDBI
service with authorization procedures for other health and mental health services and home
and community-based services to ensure that the person receives services that are the most
appropriate and effective in meeting the person's needs.

Subd. 11.

Federal approval of the autism EIDBI benefit.

(a) This section shall apply
to state plan services under title XIX of the Social Security Act when federal approval is
granted under a 1915(i) waiver or other authority which allows children eligible for medical
assistance through the TEFRA option under section 256B.055, subdivision 12, to qualify
and includes children eligible for medical assistance in families over 150 percent of the
federal poverty guidelines.

(b) The commissioner may use the federal authority for a Medicaid state plan amendment
under Early and Periodic Screening Diagnosis and Treatment (EPSDT), United States Code,
title 42, section 1396D(R)(5), or other Medicaid provision for any aspect or type of treatment
covered in this section if new federal guidance is helpful in achieving one or more of the
purposes of this section in a cost-effective manner. Notwithstanding subdivisions 2 and 3,
any treatment services submitted for federal approval under EPSDT shall include appropriate
medical criteria to qualify for the service and shall cover children through age 20 years of
age.

Subd. 12.

Autism EIDBI benefit; training provided.

After approval of the autism early
intensive intervention EIDBI benefit under this section by the Centers for Medicare and
Medicaid Services, the commissioner shall provide statewide training on the benefit for
culturally and linguistically diverse communities. Training for autism service EIDBI
providers on culturally appropriate practices must be online, accessible, and available in
multiple languages. The training for families, lead agencies, advocates, and other interested
parties must provide information about the EIDBI benefit and how to access it.

Subd. 13.

Covered services.

(a) The services described in paragraphs (b) to (i) are
eligible for reimbursement by medical assistance under this section. Services must be
provided by a qualified EIDBI provider and supervised by a QSP. An EIDBI service must
address the person's medically necessary treatment goals and must be targeted to develop,
enhance, or maintain the individual developmental skills of a person with ASD or a related
condition to improve functional communication, social or interpersonal interaction, behavioral
challenges and self-regulation, cognition, learning and play, and self-care and safety.

(b) EIDBI modalities include, but are not limited to:

(1) applied behavior analysis (ABA);

(2) developmental individual-difference relationship-based model (DIR/Floortime);

(3) early start Denver model (ESDM);

(4) PLAY project; or

(5) relationship development intervention (RDI).

(c) An EIDBI provider may use one or more of the EIDBI modalities in paragraph (b),
clauses (1) to (5), as the primary modality for treatment as a covered service, or several
EIDBI modalities in combination as the primary modality of treatment, as approved by the
commissioner. An EIDBI provider that identifies and provides assurance of qualifications
for a single specific treatment modality must document the required qualifications to meet
fidelity to the specific model. Additional EIDBI modalities not listed in paragraph (b) may
be covered upon approval by the commissioner.

(d) CMDE is a comprehensive evaluation of the person's developmental status to
determine medical necessity for EIDBI services and meets the requirements of subdivision
5. The services must be provided by a qualified CMDE provider.

(e) EIDBI intervention observation and direction is the clinical direction and oversight
of EIDBI services by the QSP, level I treatment provider, or level II treatment provider,
including developmental and behavioral techniques, progress measurement, data collection,
function of behaviors, and generalization of acquired skills for the direct benefit of a person.
EIDBI intervention observation and direction informs any modification of the methods to
support the outcomes in the ITP. EIDBI intervention observation and direction provides a
real-time response to EIDBI interventions to maximize the benefit to the person.

(f) ITP development and ITP progress monitoring is development of the initial, annual,
and progress monitoring of an ITP. ITP development and ITP progress monitoring
documents, provides oversight and ongoing evaluation of a person's treatment and progress
on targeted goals and objectives, and integrates and coordinates the person's and the person's
legal representative's information from the CMDE and ITP progress monitoring. This service
must be reviewed and completed by the QSP, and may include input from a level I treatment
provider or a level II treatment provider.

(g) Family caregiver training and counseling is specialized training and education for a
family or primary caregiver to understand the person's developmental status and help with
the person's needs and development. This service must be provided by the QSP, level I
treatment provider, or level II treatment provider.

(h) A coordinated care conference is a voluntary face-to-face meeting with the person
and the person's family to review the CMDE or ITP progress monitoring and to integrate
and coordinate services across providers and service-delivery systems to develop the ITP.
This service must be provided by the QSP and may include the CMDE provider or a level
I treatment provider or a level II treatment provider.

(i) Travel time is allowable billing for traveling to and from the person's home, school,
a community setting, or place of service outside of an EIDBI center, clinic, or office from
a specified location to provide face-to-face EIDBI intervention, observation and direction,
or family caregiver training and counseling. The person's ITP must specify the reasons the
provider must travel to the person.

(j) Medical assistance covers medically necessary EIDBI services and consultations
delivered by a licensed health care provider via telemedicine, as defined under section
256B.0625, subdivision 3b, in the same manner as if the service or consultation was delivered
in person. Medical assistance coverage is limited to three telemedicine services per person
per calendar week.

Subd. 14.

Person's rights.

A person or the person's legal representative has the right to:

(1) protection as defined under the health care bill of rights under section 144.651;

(2) designate an advocate to be present in all aspects of the person's and person's family's
services at the request of the person or the person's legal representative;

(3) be informed of the agency policy on assigning staff to a person;

(4) be informed of the opportunity to observe the person while receiving services;

(5) be informed of services in a manner that respects and takes into consideration the
person's and the person's legal representative's culture, values, and preferences in accordance
with subdivision 3a;

(6) be free from seclusion and restraint, except for emergency use of manual restraint
in emergencies as defined in section 245D.02, subdivision 8a;

(7) be under the supervision of a responsible adult at all times;

(8) be notified by the agency within 24 hours if an incident occurs or the person is injured
while receiving services, including what occurred and how agency staff responded to the
incident;

(9) request a voluntary coordinated care conference; and

(10) request a CMDE provider of the person's or the person's legal representative's
choice.

Subd. 15.

EIDBI provider qualifications.

(a) A QSP must be employed by an agency
and be:

(1) a licensed mental health professional who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
ASD diagnostics, ASD developmental and behavioral treatment strategies, and typical child
development; or

(2) a developmental or behavioral pediatrician who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
the areas of ASD diagnostics, ASD developmental and behavioral treatment strategies, and
typical child development.

(b) A level I treatment provider must be employed by an agency and:

(1) have at least 2,000 hours of supervised clinical experience or training in examining
or treating people with ASD or a related condition or equivalent documented coursework
at the graduate level by an accredited university in ASD diagnostics, ASD developmental
and behavioral treatment strategies, and typical child development or an equivalent
combination of documented coursework or hours of experience; and

(2) have or be at least one of the following:

(i) a master's degree in behavioral health or child development or related fields including,
but not limited to, mental health, special education, social work, psychology, speech
pathology, or occupational therapy from an accredited college or university;

(ii) a bachelor's degree in a behavioral health, child development, or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy, from an accredited college or university, and
advanced certification in a treatment modality recognized by the department;

(iii) a board-certified behavior analyst; or

(iv) a board-certified assistant behavior analyst with 4,000 hours of supervised clinical
experience that meets all registration, supervision, and continuing education requirements
of the certification.

(c) A level II treatment provider must be employed by an agency and must be:

(1) a person who has a bachelor's degree from an accredited college or university in a
behavioral or child development science or related field including, but not limited to, mental
health, special education, social work, psychology, speech pathology, or occupational
therapy; and meet at least one of the following:

(i) has at least 1,000 hours of supervised clinical experience or training in examining or
treating people with ASD or a related condition or equivalent documented coursework at
the graduate level by an accredited university in ASD diagnostics, ASD developmental and
behavioral treatment strategies, and typical child development or a combination of
coursework or hours of experience;

(ii) certification as a board-certified assistant behavior analyst from the Behavior Analyst
Certification Board;

(iii) is a registered behavior technician as defined by the Behavior Analyst Certification
Board; or

(iv) is certified in one of the other treatment modalities recognized by the department;
or

(2) a person who has:

(i) an associate's degree in a behavioral or child development science or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy from an accredited college or university; and

(ii) at least 2,000 hours of supervised clinical experience in delivering treatment to people
with ASD or a related condition. Hours worked as a mental health behavioral aide or level
III treatment provider may be included in the required hours of experience; or

(3) a person who has at least 4,000 hours of supervised clinical experience in delivering
treatment to people with ASD or a related condition. Hours worked as a mental health
behavioral aide or level III treatment provider may be included in the required hours of
experience; or

(4) a person who is a graduate student in a behavioral science, child development science,
or related field and is receiving clinical supervision by a QSP affiliated with an agency to
meet the clinical training requirements for experience and training with people with ASD
or a related condition; or

(5) a person who is at least 18 years of age and who:

(i) is fluent in a non-English language;

(ii) completed the level III EIDBI training requirements; and

(iii) receives observation and direction from a QSP or level I treatment provider at least
once a week until the person meets 1,000 hours of supervised clinical experience.

(d) A level III treatment provider must be employed by an agency, have completed the
level III training requirement, be at least 18 years of age, and have at least one of the
following:

(1) a high school diploma or general equivalency diploma (GED);

(2) fluency in a non-English language; or

(3) one year of experience as a primary personal care assistant, community health worker,
waiver service provider, or special education assistant to a person with ASD or a related
condition within the previous five years.

Subd. 16.

Agency duties.

(a) An agency delivering an EIDBI service under this section
must:

(1) enroll as a medical assistance Minnesota health care program provider according to
Minnesota Rules, part 9505.0195, and section 256B.04, subdivision 21, and meet all
applicable provider standards and requirements;

(2) demonstrate compliance with federal and state laws for EIDBI service;

(3) verify and maintain records of a service provided to the person or the person's legal
representative as required under Minnesota Rules, parts 9505.2175 and 9505.2197;

(4) demonstrate that while enrolled or seeking enrollment as a Minnesota health care
program provider the agency did not have a lead agency contract or provider agreement
discontinued because of a conviction of fraud; or did not have an owner, board member, or
manager fail a state or federal criminal background check or appear on the list of excluded
individuals or entities maintained by the federal Department of Human Services Office of
Inspector General;

(5) have established business practices including written policies and procedures, internal
controls, and a system that demonstrates the organization's ability to deliver quality EIDBI
services;

(6) have an office located in Minnesota;

(7) conduct a criminal background check on an individual who has direct contact with
the person or the person's legal representative;

(8) report maltreatment according to sections 626.556 and 626.557;

(9) comply with any data requests consistent with the Minnesota Government Data
Practices Act, sections 256B.064 and 256B.27;

(10) provide training for all agency staff on the requirements and responsibilities listed
in the Maltreatment of Minors Act, section 626.556, and the Vulnerable Adult Protection
Act, section 626.557, including mandated and voluntary reporting, nonretaliation, and the
agency's policy for all staff on how to report suspected abuse and neglect;

(11) have a written policy to resolve issues collaboratively with the person and the
person's legal representative when possible. The policy must include a timeline for when
the person and the person's legal representative will be notified about issues that arise in
the provision of services;

(12) provide the person's legal representative with prompt notification if the person is
injured while being served by the agency. An incident report must be completed by the
agency staff member in charge of the person. A copy of all incident and injury reports must
remain on file at the agency for at least five years from the report of the incident; and

(13) before starting a service, provide the person or the person's legal representative a
description of the treatment modality that the person shall receive, including the staffing
certification levels and training of the staff who shall provide a treatment.

(b) When delivering the ITP, and annually thereafter, an agency must provide the person
or the person's legal representative with:

(1) a written copy and a verbal explanation of the person's or person's legal
representative's rights and the agency's responsibilities;

(2) document in the person's file the date that the person or the person's legal
representative received a copy and explanation of the person's or person's legal
representative's rights and the agency's responsibilities; and

(3) reasonable accommodations to provide the information in another format or language
as needed to facilitate understanding of the person's or person's legal representative's rights
and the agency's responsibilities.

Subd. 17.

Provider shortage; authority for exceptions.

(a) In consultation with the
Early Intensive Developmental and Behavioral Intervention Advisory Council and
stakeholders, including agencies, professionals, parents of people with ASD or a related
condition, and advocacy organizations, the commissioner shall determine if a shortage of
EIDBI providers exists. For the purposes of this subdivision, "shortage of EIDBI providers"
means a lack of availability of providers who meet the EIDBI provider qualification
requirements under subdivision 15 that results in the delay of access to timely services under
this section, or that significantly impairs the ability of a provider agency to have sufficient
providers to meet the requirements of this section. The commissioner shall consider
geographic factors when determining the prevalence of a shortage. The commissioner may
determine that a shortage exists only in a specific region of the state, multiple regions of
the state, or statewide. The commissioner shall also consider the availability of various types
of treatment modalities covered under this section.

(b) The commissioner, in consultation with the Early Intensive Developmental and
Behavioral Intervention Advisory Council and stakeholders, must establish processes and
criteria for granting an exception under this paragraph. The commissioner may grant an
exception only if the exception would not compromise a person's safety and not diminish
the effectiveness of the treatment. The commissioner may establish an expiration date for
an exception granted under this paragraph. The commissioner may grant an exception for
the following:

(1) EIDBI provider qualifications under this section;

(2) medical assistance provider enrollment requirements under section 256B.04,
subdivision 21; or

(3) EIDBI provider or agency standards or requirements.

(c) If the commissioner, in consultation with the Early Intensive Developmental and
Behavioral Intervention Advisory Council and stakeholders, determines that a shortage no
longer exists, the commissioner must submit a notice that a shortage no longer exists to the
chairs and ranking minority members of the senate and the house of representatives
committees with jurisdiction over health and human services. The commissioner must post
the notice for public comment for 30 days. The commissioner shall consider public comments
before submitting to the legislature a request to end the shortage declaration. The
commissioner shall annually provide an update on the status of the provider shortage and
exceptions granted to the chairs and ranking minority members of the senate and house of
representatives committees with jurisdiction over health and human services. The
commissioner shall not declare the shortage of EIBDI providers ended without direction
from the legislature to declare it ended.

EFFECTIVE DATE.

Subdivisions 15 and 17 are effective the day following final
enactment. Subdivisions 1 to 9, 13, 14, and 16 are effective July 1, 2017.