HF 1186

2nd Engrossment - 90th Legislature (2017 - 2018) Posted on 02/20/2018 12:59pm

A bill for an act
relating to human services; modifying provisions related to mental health services;
modifying the definition of mental health practitioner; modifying certified peer
specialist certification requirements; amending Minnesota Statutes 2016, sections
245.462, subdivision 17; 245.4871, subdivision 26; 245.8261, subdivision 4;
256B.0615, subdivision 5; 256B.0616, subdivision 5; 256B.0943, subdivisions 1,
9, 13.

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

Section 1.

Minnesota Statutes 2016, section 245.462, subdivision 17, is amended to read:

Subd. 17.

Mental health practitioner.

"Mental health practitioner" means a person
providing services to persons with mental illness who is qualified in at least one of the
following ways:

(1) holds a bachelor's degree in one of the behavioral sciences or related fields from an
accredited college or university and:

(i) has at least 2,000 hours of supervised experience in the delivery of services to persons
with mental illness; deleted text begin or
deleted text end

(ii) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to persons with mental illness, and receives clinical supervision from a mental health
professional at least once a week until the requirement of 2,000 hours of supervised
experience is met; new text begin or
new text end

new text begin (iii) is working in a day treatment program under section 245.4712, subdivision 2;
new text end

(2) has at least 6,000 hours of supervised experience in the delivery of services to persons
with mental illness;

(3) is a graduate student in one of the behavioral sciences or related fields and is formally
assigned by an accredited college or university to an agency or facility for clinical training;
or

(4) holds a master's or other graduate degree in one of the behavioral sciences or related
fields from an accredited college or university and has less than 4,000 hours post-master's
experience in the treatment of mental illness.

Sec. 2.

Minnesota Statutes 2016, section 245.4871, subdivision 26, is amended to read:

Subd. 26.

Mental health practitioner.

"Mental health practitioner" means a person
providing services to children with emotional disturbances. A mental health practitioner
must have training and experience in working with children. A mental health practitioner
must be qualified in at least one of the following ways:

(1) holds a bachelor's degree in one of the behavioral sciences or related fields new text begin , including,
but not limited to, social work, psychology, sociology, community counseling, family social
science, child development/child psychology, community mental health, addiction counseling,
counseling/guidance, and special education new text end from an accredited college or university and:

(i) has at least 2,000 hours of supervised experience in the delivery of mental health
services to children with emotional disturbances; or

(ii) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to children with emotional disturbances, and receives clinical supervision from a mental
health professional at least once a week until the requirement of 2,000 hours of supervised
experience is met;

(2) has at least 6,000 hours of supervised experience in the delivery of mental health
services to children with emotional disturbances; hours worked as a mental health behavioral
aide I or II under section 256B.0943, subdivision 7, may be included in the 6,000 hours of
experience;

(3) is a graduate student in one of the behavioral sciences or related fields and is formally
assigned by an accredited college or university to an agency or facility for clinical training;
or

(4) holds a master's or other graduate degree in one of the behavioral sciences or related
fields from an accredited college or university.

Sec. 3.

Minnesota Statutes 2016, section 245.8261, subdivision 4, is amended to read:

Subd. 4.

Allowable procedures.

(a) A provider may use one or more of the following
restrictive procedures:

(1) physical escort;

(2) physical holding;

(3) seclusion; and

(4) the limited use of mechanical restraints only in emergency situations.

(b) A provider shall permit use of restrictive procedures only by deleted text begin a mental health
professional under section 245.4871, subdivision 27, or by a mental health practitioner
under section 245.4871, subdivision 26, deleted text end new text begin a program staff new text end who new text begin has completed the required
training and who new text end is acting under the clinical supervision of a mental health professional.

Sec. 4.

Minnesota Statutes 2016, section 256B.0615, subdivision 5, is amended to read:

Subd. 5.

Certified peer specialist training and certification.

The commissioner of
human services shall develop a training and certification process for certified peer specialists,
who must be at least 21 years of age deleted text begin and have a high school diploma or its equivalent deleted text end . The
candidates must have had a primary diagnosis of mental illness, be a current or former
consumer of mental health services, and must demonstrate leadership and advocacy skills
and a strong dedication to recovery. The training curriculum must teach participating
consumers specific skills relevant to providing peer support to other consumers. In addition
to initial training and certification, the commissioner shall develop ongoing continuing
educational workshops on pertinent issues related to peer support counseling.

Sec. 5.

Minnesota Statutes 2016, section 256B.0616, subdivision 5, is amended to read:

Subd. 5.

Certified family peer specialist training and certification.

The commissioner
shall develop a training and certification process for certified family peer specialists who
must be at least 21 years of age deleted text begin and have a high school diploma or its equivalent deleted text end . The
candidates must have raised or be 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 support counseling.

Sec. 6.

Minnesota Statutes 2016, 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 to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. 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) "Clinical trainee" means a mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item C.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a. Crisis
assistance entails the development of a written plan to assist a child's family to contend with
a potential crisis and is distinct from the immediate provision of crisis intervention services.

(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 mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a multidisciplinary team, under the clinical supervision of a
mental health professional.

(g) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 9505.0372,
subpart 1.

(h) "Direct service time" means the time that a mental health professional, clinical trainee,
mental health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family or providing covered telemedicine services. Direct service time
includes time in which the provider obtains a client's history, develops a client's treatment
plan, records individual treatment outcomes, 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 or maintaining clinical
records.

(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.

(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. The individual behavioral plan may be incorporated into the child's individual
treatment plan so long as the behavioral plan is separately communicable to the mental
health behavioral aide.

(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part 9505.0371,
subpart 7.

(m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3), to assist a child retain or generalize psychosocial skills as previously
trained 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 practitioner" means an individual as defined in Minnesota Rules, part
deleted text begin , subpart 17 deleted text end new text begin 9505.0371, subpart 5, item B, except that a practitioner working in
a day treatment setting may be exempt from the 2,000-hour supervised experience
requirement if the day treatment provider delivers 40 hours of training to the practitioner
within six months of employment and the practitioner receives weekly clinical supervision
from a mental health professional until the practitioner meets the 2,000 hours of supervised
experience new text end .

(o) "Mental health professional" means an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18.

(p) "Mental health service plan development" includes:

(1) the development, review, and revision of a child's individual treatment plan, as
provided in Minnesota Rules, part 9505.0371, subpart 7, including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and

(2) administering standardized outcome measurement instruments, determined and
updated by the commissioner, as periodically needed to evaluate the effectiveness of
treatment for children receiving clinical services and reporting outcome measures, as required
by the commissioner.

(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).

(r) "Psychotherapy" means the treatment of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plan.

(s) "Rehabilitative services" or "psychiatric rehabilitation services" means a series or
multidisciplinary combination of psychiatric and psychosocial interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
psychotherapy to address internal psychological, emotional, and intellectual processing
deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.

(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision 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 enable the child
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 service delivery requirements under subdivision 9, paragraph (b), clause (2).

Sec. 7.

Minnesota Statutes 2016, section 256B.0943, subdivision 9, is amended to read:

Subd. 9.

Service delivery criteria.

(a) In delivering services under this section, a certified
provider entity must ensure that:

(1) each individual provider's caseload size permits the provider to deliver services to
both clients with severe, complex needs and clients with less intensive needs. The provider's
caseload size should reasonably enable the provider to play an active role in service planning,
monitoring, and delivering services to meet the client's and client's family's needs, as specified
in each client's individual treatment plan;

(2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and

(3) a day treatment program is provided to a group of clients by a multidisciplinary team
under the clinical supervision of a mental health professional. The day treatment program
must be provided in and by: (i) an outpatient hospital accredited by the Joint Commission
on Accreditation of Health Organizations and licensed under sections 144.50 to 144.55; (ii)
a community mental health center under section 245.62; or (iii) an entity that is certified
under subdivision 4 to operate a program that meets the requirements of section 245.4884,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment
program must stabilize the client's mental health status while developing and improving the
client's independent living and socialization skills. The goal of the day treatment program
must be to reduce or relieve the effects of mental illness and provide training to enable the
client to live in the community. The program must be available year-round at least three to
five days per week, two or three hours per day, unless the normal five-day school week is
shortened by a holiday, weather-related cancellation, or other districtwide reduction in a
school week. A child transitioning into or out of day treatment must receive a minimum
treatment of one day a week for a two-hour time block. The two-hour time block must
include at least one hour of patient and/or family or group psychotherapy. The remainder
of the structured treatment program may include patient and/or family or group
psychotherapy, and individual or group skills training, if included in the client's individual
treatment plan. Day treatment programs are not part of inpatient or residential treatment
services. When a day treatment group that meets the minimum group size requirement
temporarily falls below the minimum group size because of a member's temporary absence,
medical assistance covers a group session conducted for the group members in attendance.
A day treatment program may provide fewer than the minimally required hours for a
particular child during a billing period in which the child is transitioning into, or out of, the
program.

(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:

(1) patient and/or family, family, and group psychotherapy must be delivered as specified
in Minnesota Rules, part 9505.0372, subpart 6. Psychotherapy to address the child's
underlying mental health disorder must be documented as part of the child's ongoing
treatment. A provider must deliver, or arrange for, medically necessary psychotherapy,
unless the child's parent or caregiver chooses not to receive it. When a provider delivering
other services to a child under this section deems it not medically necessary to provide
psychotherapy to the child for a period of 90 days or longer, the provider entity must
document the medical reasons why psychotherapy is not necessary. When a provider
determines that a child needs psychotherapy but psychotherapy cannot be delivered due to
a shortage of licensed mental health professionals in the child's community, the provider
must document the lack of access in the child's medical record;

(2) individual, family, or group skills training must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills training is subject to the
following requirements:

(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;

(ii) skills training delivered to a child or the child's family 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;

(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;

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

(v) 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:

(A) one mental health professional or one clinical trainee or mental health practitioner
under supervision of a licensed mental health professional must work with a group of three
to eight clients; or

(B) two mental health professionals, two clinical trainees or mental health practitioners
under supervision of a licensed mental health professional, or one mental health professional
or clinical trainee and one mental health practitioner must work with a group of nine to 12
clients;

(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and

(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;

(3) crisis assistance to a child and family must include development of a written plan
that anticipates the particular factors specific to the child that may precipitate a psychiatric
crisis for the child in the near future. The written plan must document actions that the family
should be prepared to take to resolve or stabilize a crisis, such as advance arrangements for
direct intervention and support services to the child and the child's family. Crisis assistance
must include preparing resources designed to address abrupt or substantial changes in the
functioning of the child or the child's family when sudden change in behavior or a loss of
usual coping mechanisms is observed, or the child begins to present a danger to self or
others;

(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3), and which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:

(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;

(ii) performing as a practice partner or role-play partner;

(iii) reinforcing the child's accomplishments;

(iv) generalizing skill-building activities in the child's multiple natural settings;

(v) assigning further practice activities; and

(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.

To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;

(5) direction of a mental health behavioral aide must include the following:

(i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child by a mental health professional or mental health practitioner for at least
a total of one hour during every 40 hours of service provided to a child; and

(ii) immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;

(6) mental health service plan development must be performed in consultation with the
child's family and, when appropriate, with other key participants in the child's life by the
child's treating mental health professional or clinical trainee or by a mental health practitioner
and approved by the treating mental health professional. Treatment plan drafting consists
of development, review, and revision by face-to-face or electronic communication. The
provider must document events, including the time spent with the family and other key
participants in the child's life to review, revise, and sign the individual treatment plan new text begin .
Notwithstanding Minnesota Rules, part 9505.0371, subpart 7, medical assistance covers
service plan development before completion of the child's individual treatment plan. Service
plan development is covered only if a treatment plan is completed for the child. If upon
review, it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan development new text end ; and

(7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.

Sec. 8.

Minnesota Statutes 2016, section 256B.0943, subdivision 13, is amended to read:

Subd. 13.

Exception to excluded services.

Notwithstanding subdivision 12, up to 15
hours of children's therapeutic services and supports provided within a six-month period to
a child with severe emotional disturbance who is residing in a hospital; deleted text begin a group home as
defined in Minnesota Rules, parts 2960.0130 to 2960.0220; deleted text end a residential treatment facility
licensed under Minnesota Rules, parts 2960.0580 to 2960.0690; new text begin a psychiatric residential
treatment facility under section 256B.0625, subdivision 45a; new text end a regional treatment center;
or other institutional group setting or who is participating in a program of partial
hospitalization are eligible for medical assistance payment if part of the discharge plan.