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HF 1390

as introduced - 92nd Legislature (2021 - 2022) Posted on 02/22/2021 02:31pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; modifying certified community behavioral health clinic
provisions; establishing an advisory working group; authorizing rulemaking;
requiring a report; amending Minnesota Statutes 2020, sections 245.735,
subdivisions 3, 5, by adding subdivisions; 256B.0625, subdivision 5m; repealing
Minnesota Statutes 2020, section 245.735, subdivisions 1, 2, 4.

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

Section 1.

Minnesota Statutes 2020, section 245.735, subdivision 3, is amended to read:


Subd. 3.

Certified community behavioral health clinics.

(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs)new text begin that satisfy all federal requirements necessary for CCBHCs certified under this
chapter to be eligible for reimbursement under medical assistance, without restrictions on
service delivery based on geographic area or region
new text end. Entities that choose to be CCBHCs
must:

deleted text begin (1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;
deleted text end

new text begin (1) comply with state licensing requirements and other requirements issued by the
commissioner according to subdivision 3a;
new text end

(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;

(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;

(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;

(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;

(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization servicesnew text begin, such as mobile
crisis teams
new text end; screening, assessment, and diagnosis services, including risk assessments and
level of care determinations; person- and family-centered treatment planning; outpatient
mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veteransdeleted text begin;deleted text endnew text begin. CCBHCs must directly provide the majority
of these services to enrollees, but may coordinate some services with another entity through
a collaboration or agreement, pursuant to paragraph (b);
new text end

(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:

(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and

(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;

(8) be certified as mental health clinics under section 245.69, subdivision 2;

(9) comply with standards new text beginestablished by the commissioner new text endrelating to deleted text beginmental health
services in Minnesota Rules, parts 9505.0370 to 9505.0372
deleted text endnew text begin CCBHC screenings, assessments,
and evaluations
new text end;

(10) be licensed to provide substance use disorder treatment under chapter 245G;

(11) be certified to provide children's therapeutic services and supports under section
256B.0943;

(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;

(13) be enrolled to provide mental health crisis response services under sections
256B.0624 and 256B.0944;

(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;

(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;

(16) provide services that comply with the evidence-based practices described in
paragraph (e); and

(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.

(b) If deleted text beginan entitydeleted text endnew text begin a certified CCBHCnew text end is unable to provide one or more of the services listed
in paragraph (a), clauses (6) to (17), the deleted text begincommissioner may certify the entity as adeleted text end CCBHCdeleted text begin,
if the entity has a current
deleted text endnew text begin maynew text end contract with another entity that has the required authority
to provide that service and that meets deleted text beginfederal CCBHCdeleted text endnew text begin the followingnew text end criteria as a designated
collaborating organizationdeleted text begin, or, to the extent allowed by the federal CCBHC criteria, the
commissioner may approve a referral arrangement. The CCBHC must meet federal
requirements regarding the type and scope of services to be provided directly by the CCBHC.
deleted text endnew text begin:
new text end

new text begin (1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under paragraph (a), clause (6);
new text end

new text begin (2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
new text end

new text begin (3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
new text end

new text begin (4) the entity meets any additional requirements issued by the commissioner under
subdivision 3a.
new text end

(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m
, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.

(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirementsnew text begin
for services reimbursed under medical assistance
new text end. If standards overlap, the commissioner
may substitute all or a part of a licensure or certification that is substantially the same as
another licensure or certification. The commissioner shall consult with stakeholders, as
described in subdivision 4, before granting variances under this provision. For the CCBHC
that is certified but not approved for prospective payment under section 256B.0625,
subdivision 5m
, the commissioner may grant a variance under this paragraph if the variance
does not increase the state share of costs.

(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.

new text begin (f) The commissioner may grant a variance to allow an applicant for CCBHC certification
to demonstrate compliance with standards in paragraph (a) if the CCBHC will contract with
a designated collaborating organization to provide all services for which a particular licensure
or certification listed in paragraph (a) is required.
new text end

new text begin (g) The commissioner shall provide a CCBHC with adequate notice of the commissioner's
decision regarding a variance request. The notice of the commissioner's decision must
include information providing for an appeals process through which the CCBHC may appeal
the commissioner's decision.
new text end

deleted text begin (f)deleted text endnew text begin (h)new text end The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.

Sec. 2.

Minnesota Statutes 2020, section 245.735, is amended by adding a subdivision to
read:


new text begin Subd. 3a. new text end

new text begin Additional CCBHC criteria; rulemaking. new text end

new text begin Notwithstanding the requirements
under this section, any criteria and requirements established by the commissioner to
implement this section shall be adopted as rules published by the commissioner with notice
and a public comment period. Sections 14.125 and 14.128 do not apply to rulemaking under
this subdivision.
new text end

Sec. 3.

Minnesota Statutes 2020, section 245.735, subdivision 5, is amended to read:


Subd. 5.

Information systems support.

The commissioner and the state chief information
officer shall provide information systems support to the projects as necessary to comply
with new text beginstate and new text endfederal requirements.

Sec. 4.

Minnesota Statutes 2020, section 245.735, is amended by adding a subdivision to
read:


new text begin Subd. 6. new text end

new text begin Demonstration entities. new text end

new text begin The commissioner may operate the demonstration
program established by section 223 of the Protecting Access to Medicare Act if federal
funding for the demonstration program remains available from the United States Department
of Health and Human Services. To the extent practicable, the commissioner shall align the
requirements of the demonstration program with the requirements under this section for
CCBHCs receiving medical assistance reimbursement. A CCBHC may not apply to
participate as a billing provider in both the CCBHC federal demonstration and the benefit
for CCBHCs under the medical assistance program.
new text end

Sec. 5.

Minnesota Statutes 2020, section 256B.0625, subdivision 5m, is amended to read:


Subd. 5m.

Certified community behavioral health clinic services.

(a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.

(b) The commissioner shall deleted text beginestablish standards and methodologies for adeleted text end new text beginreimburse
CCBHCs on a per-visit basis under the
new text endprospective payment system for medical assistance
payments deleted text beginfor services delivered by a CCBHC, in accordance with guidance issued by the
Centers for Medicare and Medicaid Services
deleted text endnew text begin as described in paragraph (c)new text end. The commissioner
shall include a quality deleted text beginbonusdeleted text endnew text begin incentivenew text end payment in the prospective payment system deleted text beginbased
on federal criteria
deleted text endnew text begin, as described in paragraph (e)new text end. There is no county share for medical
assistance services when reimbursed through the CCBHC prospective payment system.

(c) deleted text beginUnless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal section
223 CCBHC demonstration, except:
deleted text endnew text begin The commissioner shall ensure that the prospective
payment system for CCBHC payments under medical assistance meets the following
requirements:
new text end

new text begin (1) the prospective payment rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
costs for CCBHCs divided by the total annual number of CCBHC visits. For calculating
the payment rate, total annual visits include visits covered by medical assistance and visits
not covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
new text end

new text begin (2) payment shall be limited to one payment per day per medical assistance enrollee for
each CCBHC visit eligible for reimbursement. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
new text end

new text begin (3) new payment rates set by the commissioner for newly certified CCBHCs under
section 245.735, subdivision 3, shall be based on rates for established CCBHCs with a
similar scope of services. If no comparable CCBHC exists, the commissioner shall establish
a clinic-specific rate using audited historical cost report data adjusted for the estimated cost
of delivering CCBHC services, including the estimated cost of providing the full scope of
services and the projected change in visits resulting from the change in scope;
new text end

deleted text begin (1)deleted text endnew text begin (4)new text end the commissioner shall rebase CCBHC rates at leastnew text begin oncenew text end every three years;

deleted text begin (2)deleted text endnew text begin (5)new text end the commissioner shall provide for a 60-day appeals process new text beginafter notice of the
results
new text endof the rebasing;

deleted text begin (3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;
deleted text end

deleted text begin (4)deleted text endnew text begin (6)new text end the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;

deleted text begin (5)deleted text endnew text begin (7)new text end payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap paymentsnew text begin. The commissioner shall
complete the phase-out of CCBHC wrap payments no later than July 1, 2021, for CCBHCs
reimbursed under this chapter, with a final settlement of payments due made payable to
CCBHCs no later than 18 months thereafter
new text end;

deleted text begin (6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services;
deleted text end

deleted text begin (7)deleted text endnew text begin (8)new text end the prospective payment rate for each CCBHC shall be deleted text beginadjusteddeleted text endnew text begin updatednew text end annually
bynew text begin rebasing or by trending each provider-specific rate bynew text end the Medicare Economic Index deleted text beginas
defined for the federal section 223 CCBHC demonstration
deleted text endnew text begin for primary care services.
CCBHCs must provide data on costs and visits to the state annually using the CCBHC cost
report established by the commissioner
new text end; and

new text begin (9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services that are expected to adjust the CCBHC payment rate by 2.5 percent or more. The
CCBHC must provide the commissioner with information regarding the changes in the
scope of services, including the estimated cost of providing the new or modified services
and any projected increase or decrease in the number of visits resulting from the change.
Rate adjustments for changes in scope are limited to one per year per CCBHC and are
effective on the date of the annual CCBHC rate update.
new text end

deleted text begin (8) the commissioner shall seek federal approval for a CCBHC rate methodology that
allows for rate modifications based on changes in scope for an individual CCBHC, including
for changes to the type, intensity, or duration of services. Upon federal approval, a CCBHC
may submit a change of scope request to the commissioner if the change in scope would
result in a change of 2.5 percent or more in the prospective payment system rate currently
received by the CCBHC. CCBHC change of scope requests must be according to a format
and timeline to be determined by the commissioner in consultation with CCBHCs.
deleted text end

(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the prospective payment rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed the amount equal
to any increase in rates that results from this provision. This paragraph expires if federal
approval is not received for this paragraph at any time.

new text begin (e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
new text end

new text begin (1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the prospective payment system described in
paragraph (c);
new text end

new text begin (2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
new text end

new text begin (3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
new text end

new text begin (4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
new text end

new text begin (f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner no later than January 1 of the
following calendar year, if:
new text end

new text begin (1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
new text end

new text begin (2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by the managed care plan.
new text end

Sec. 6. new text beginDIRECTION TO THE COMMISSIONER; CERTIFIED COMMUNITY
BEHAVIORAL HEALTH CLINIC ADVISORY WORKING GROUP.
new text end

new text begin By July 1, 2021, the commissioner of human services shall establish an advisory working
group, collaborating with certified community behavioral health clinics (CCBHCs) and
other relevant stakeholders to identify regulatory options that balance optimal program
oversight, program integrity, and compliance with state and federal requirements with the
desire to minimize the administrative burden and costs for providers. The working group
shall review and make recommendations on available options for licensing or certifying
CCBHCs that receive medical assistance reimbursement, including specific requirements
for CCBHCs and possible state licensing or certification authorities. The commissioner
shall submit a written report summarizing the advisory working group's findings and
recommendations to the members of the legislative committees with jurisdiction over health
and human services no later than January 10, 2022.
new text end

Sec. 7. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2020, section 245.735, subdivisions 1, 2, and 4, new text end new text begin are repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 21-02643

245.735 EXCELLENCE IN MENTAL HEALTH DEMONSTRATION PROJECT.

Subdivision 1.

Excellence in Mental Health demonstration project.

The commissioner shall develop and execute projects to reform the mental health system by participating in the Excellence in Mental Health demonstration project.

Subd. 2.

Federal proposal.

The commissioner shall develop and submit to the United States Department of Health and Human Services a proposal for the Excellence in Mental Health demonstration project. The proposal shall include any necessary state plan amendments, waivers, requests for new funding, realignment of existing funding, and other authority necessary to implement the projects specified in subdivision 3.

Subd. 4.

Public participation.

In developing and implementing CCBHCs under subdivision 3, the commissioner shall consult, collaborate, and partner with stakeholders, including but not limited to mental health providers, substance use disorder treatment providers, advocacy organizations, licensed mental health professionals, counties, tribes, hospitals, other health care providers, and Minnesota public health care program enrollees who receive mental health services and their families.