HF 1611

as introduced - 89th Legislature (2015 - 2016) Posted on 03/09/2015 02:00pm

A bill for an act
relating to mental health; authorizing a demonstration project; modifying
definitions and requirements related to mental health services; authorizing
rulemaking; appropriating money; amending Minnesota Statutes 2014, sections
256B.0622; 256B.0624, subdivision 7; proposing coding for new law in
Minnesota Statutes, chapter 245.

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

Section 1.

new text begin [245.735] EXCELLENCE IN MENTAL HEALTH DEMONSTRATION
PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Excellence in Mental Health demonstration project. new text end

new text begin The
commissioner of human services shall develop and execute projects to reform the mental
health system by participating in the Excellence in Mental Health demonstration project.
new text end

new text begin Subd. 2. new text end

new text begin Federal proposal. new text end

new text begin 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 4.
new text end

new text begin Subd. 3. new text end

new text begin Rules. new text end

new text begin By January 15, 2017, the commissioner shall adopt rules that meet
the criteria in subdivision 4, paragraph (a), to establish standards for state certification
of community behavioral health clinics, and rules that meet the criteria in subdivision 4,
paragraph (b), to implement a prospective payment system for medical assistance payment
of mental health services delivered in certified community behavioral health clinics. These
rules shall comply with federal requirements for certification of community behavioral
health clinics and the prospective payment system and shall apply to community mental
health centers, mental health clinics, mental health residential treatment centers, essential
community providers, federally qualified health centers, and rural health clinics. The
commissioner may adopt rules under this subdivision using the expedited process in
section 14.389.
new text end

new text begin Subd. 4. new text end

new text begin Reform projects. new text end

new text begin (a) The commissioner shall establish standards
for state certification of a clinic as a certified community behavioral health clinic in
accordance with the criteria published on or before September 1, 2015, by the United
States Department of Health and Human Services. Certification standards established by
the commissioner shall require that:
new text end

new text begin (1) clinic staff have backgrounds in diverse disciplines, include licensed mental
health professionals, and are culturally and linguistically trained to serve the needs of the
clinic's patient population;
new text end

new text begin (2) clinic services are available and accessible and crisis management services
are available 24 hours per day;
new text end

new text begin (3) fees for clinic services are established using a sliding fee scale and patients are
not denied services or subject to limited services due to an inability to pay for services;
new text end

new text begin (4) clinics provide coordination of care across settings and providers to ensure
seamless transitions for patients across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with federally qualified health centers, inpatient
psychiatric facilities, substance use and detoxification facilities, community-based mental
health providers, and other community services, supports, and providers. Community
services, supports, and providers include, but are not limited to, 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;
new text end

new text begin (5) services provided by clinics include:
new text end

new text begin (i) crisis mental health services, emergency crisis intervention services, and
stabilization services;
new text end

new text begin (ii) screening, assessment, and diagnosis services, including risk assessments and
level of care determinations;
new text end

new text begin (iii) patient-centered treatment planning;
new text end

new text begin (iv) outpatient mental health and substance use services;
new text end

new text begin (v) targeted case management;
new text end

new text begin (vi) psychiatric rehabilitation services;
new text end

new text begin (vii) peer support and counselor services and family support services; and
new text end

new text begin (viii) intensive community-based mental health services, including mental health
services for members of the armed forces and veterans; and
new text end

new text begin (6) clinics comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data.
new text end

new text begin (b) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for mental health services delivered by
certified community behavioral health clinics in accordance with guidance issued on or
before September 1, 2015, by the Centers for Medicare and Medicaid Services. During the
operation of the demonstration project, payments must comply with federal requirements
for a 90 percent enhanced federal medical assistance payment.
new text end

new text begin Subd. 5. new text end

new text begin Public participation. new text end

new text begin In developing the projects under subdivision 4, the
commissioner shall consult with mental health providers, advocacy organizations, licensed
mental health professionals, and Minnesota health care program enrollees who receive
mental health services and their families.
new text end

new text begin Subd. 6. new text end

new text begin Information systems support. new text end

new text begin The commissioner and the state chief
information officer shall provide information systems support to the projects as necessary
to comply with federal requirements and the deadlines in subdivision 3.
new text end

Sec. 2.

Minnesota Statutes 2014, section 256B.0622, is amended to read:

256B.0622 INTENSIVE REHABILITATIVE MENTAL HEALTH SERVICES.

Subdivision 1.

Scope.

Subject to federal approval, medical assistance covers
medically necessary, deleted text begin intensive nonresidential deleted text end new text begin assertive community treatment new text end and new text begin intensive
new text end residential rehabilitative mental health services as defined in subdivision 2, for recipients
as defined in subdivision 3, when the services are provided by an entity meeting the
standards in this section.

Subd. 2.

Definitions.

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

(a) deleted text begin "Intensive nonresidential rehabilitative mental health services" means adult
rehabilitative mental health services as defined in section 256B.0623, subdivision 2,
paragraph (a), except that these services are provided by a multidisciplinary staff using
a total team approach consistent with assertive community treatment, the Fairweather
Lodge treatment model, as defined by the standards established by the National Coalition
for Community Living, and other evidence-based practices, and directed to recipients with
a serious mental illness who require intensive services. deleted text end new text begin "Assertive community treatment"
means intensive nonresidential rehabilitative mental health services provided according
to the evidence-based practice of assertive community treatment. Core elements of this
service include, but are not limited to:
new text end

new text begin (1) a multidisciplinary staff who utilize a total team approach and who serve as a
fixed point of responsibility for all service delivery;
new text end

new text begin (2) providing services 24 hours per day and seven days per week;
new text end

new text begin (3) providing the majority of services in a community setting;
new text end

new text begin (4) offering a low ratio of recipients to staff;
new text end

new text begin (5) assisting with employment and engagement with family or friends; and
new text end

new text begin (6) providing service that is not time-limited.
new text end

(b) "Intensive residential rehabilitative mental health services" means short-term,
time-limited services provided in a residential setting to recipients who are in need of
more restrictive settings and are at risk of significant functional deterioration if they do
not receive these services. Services are designed to develop and enhance psychiatric
stability, personal and emotional adjustment, self-sufficiency, and skills to live in a more
independent setting. Services must be directed toward a targeted discharge date with
specified client outcomes deleted text begin and must be consistent with the Fairweather Lodge treatment
model as defined in paragraph (a), and other evidence-based practices deleted text end .

(c) "Evidence-based practices" are nationally recognized mental health services that
are proven by substantial research to be effective in helping individuals with serious
mental illness obtain specific treatment goals.

(d) "Overnight staff" means a member of the intensive residential rehabilitative
mental health treatment team who is responsible during hours when recipients are
typically asleep.

(e) "Treatment team" means all staff who provide services under this section to
recipients. At a minimum, this includes the clinical supervisor, mental health professionals
as defined in section 245.462, subdivision 18, clauses (1) to (6); mental health practitioners
as defined in section 245.462, subdivision 17; mental health rehabilitation workers under
section 256B.0623, subdivision 5, clause deleted text begin (3) deleted text end new text begin (4) new text end ; and certified peer specialists under
section 256B.0615.

Subd. 3.

Eligibility.

An eligible recipient is an individual who:

(1) is age 18 or older;

(2) is eligible for medical assistance;

(3) is diagnosed with a mental illness;

(4) because of a mental illness, has substantial disability and functional impairment
in three or more of the areas listed in section 245.462, subdivision 11a, so that
self-sufficiency is markedly reduced;

(5) has one or more of the following: a history of two or more new text begin or prolonged new text end inpatient
hospitalizations in the past year, significant independent living instability, homelessness,
or very frequent use of mental health and related services yielding poor outcomes; and

(6) in the written opinion of a licensed mental health professional, has the need for
mental health services that cannot be met with other available community-based services,
or is likely to experience a mental health crisis or require a more restrictive setting if
intensive rehabilitative mental health services are not provided.

Subd. 4.

Provider certification and contract requirements.

(a) The deleted text begin intensive
nonresidential rehabilitative mental health services deleted text end new text begin assertive community treatment new text end
provider must:

(1) have a contract with the host county to provide intensive adult rehabilitative
mental health services; and

(2) be certified by the commissioner as being in compliance with this section and
section 256B.0623.

(b) The intensive residential rehabilitative mental health services provider must:

(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;

(2) not exceed 16 beds per site;

(3) comply with the additional standards in this section; and

(4) have a contract with the host county to provide these services.

(c) The commissioner shall develop procedures for counties and providers to submit
contracts and other documentation as needed to allow the commissioner to determine
whether the standards in this section are met.

Subd. 5.

Standards applicable to both deleted text begin nonresidential deleted text end new text begin assertive community
treatment new text end and residential providers.

(a) Services must be provided by qualified staff as
defined in section 256B.0623, subdivision 5, who are trained and supervised according to
section 256B.0623, subdivision 6, except that mental health rehabilitation workers acting
as overnight staff are not required to comply with section 256B.0623, subdivision 5,
clause deleted text begin (3) deleted text end new text begin (4), item new text end (iv).

(b) The clinical supervisor must be an active member of the treatment team. The
treatment team must meet with the clinical supervisor at least weekly to discuss recipients'
progress and make rapid adjustments to meet recipients' needs. The team meeting shall
include recipient-specific case reviews and general treatment discussions among team
members. Recipient-specific case reviews and planning must be documented in the
individual recipient's treatment record.

(c) Treatment staff must have prompt access in person or by telephone to a mental
health practitioner or mental health professional. The provider must have the capacity to
promptly and appropriately respond to emergent needs and make any necessary staffing
adjustments to assure the health and safety of recipients.

(d) The initial functional assessment must be completed within ten days of intake
and updated at least every deleted text begin three months deleted text end new text begin 30 days for intensive residential services and
every six months for assertive community treatment, new text end or prior to discharge from the
service, whichever comes first.

(e) The initial individual treatment plan must be completed within ten days of
intake new text begin for assertive community treatment and within 24 hours of admission for intensive
residential services. Within ten days of admission, the initial treatment plan must be
refined and further developed for intensive residential services, except for providers
certified according to Minnesota Rules, parts 9533.0010 to 9533.0180. The individual
treatment plan must be reviewed with the recipient new text end and deleted text begin reviewed and deleted text end updated at least
monthly deleted text begin with the recipient deleted text end new text begin for intensive residential services and at least every six months
for assertive community treatment new text end .

Subd. 6.

Standards for intensive residential rehabilitative mental health services.

(a) The provider of intensive residential services must have sufficient staff to provide
24-hour-per-day coverage to deliver the rehabilitative services described in the treatment
plan and to safely supervise and direct the activities of recipients given the recipient's level
of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider
must have the capacity within the facility to provide integrated services for chemical
dependency, illness management services, and family education when appropriate.

(b) At a minimum:

(1) staff must be available and provide direction and supervision whenever recipients
are present in the facility;

(2) staff must remain awake during all work hours;

(3) there must be a staffing ratio of at least one to nine recipients for each day and
evening shift. If more than nine recipients are present at the residential site, there must be
a minimum of two staff during day and evening shifts, one of whom must be a mental
health practitioner or mental health professional;

(4) if services are provided to recipients who need the services of a medical
professional, the provider shall assure that these services are provided either by the
provider's own medical staff or through referral to a medical professional; and

(5) the provider must assure the timely availability of a licensed registered
nurse, either directly employed or under contract, who is responsible for ensuring the
effectiveness and safety of medication administration in the facility and assessing patients
for medication side effects and drug interactions.

Subd. 7.

Additional standards for deleted text begin nonresidential services deleted text end new text begin assertive community
treatment new text end .

The standards in this subdivision apply to deleted text begin intensive nonresidential
rehabilitative mental health deleted text end new text begin assertive community treatment new text end services.

(1) The treatment team must use team treatment, not an individual treatment model.

(2) The clinical supervisor must function as a practicing clinician at least on a
part-time basis.

(3) The staffing ratio must not exceed ten recipients to one full-time equivalent
treatment team position.

(4) Services must be available at times that meet client needs.

(5) The treatment team must actively and assertively engage and reach out to the
recipient's family members and significant others, after obtaining the recipient's permission.

(6) The treatment team must establish ongoing communication and collaboration
between the team, family, and significant others and educate the family and significant
others about mental illness, symptom management, and the family's role in treatment.

(7) The treatment team must provide interventions to promote positive interpersonal
relationships.

Subd. 8.

Medical assistance payment for intensive rehabilitative mental health
services.

(a) Payment for new text begin intensive new text end residential deleted text begin and nonresidential deleted text end services new text begin and assertive
community treatment new text end in this section shall be based on one daily rate per provider inclusive
of the following services received by an eligible recipient in a given calendar day: all
rehabilitative services under this section, staff travel time to provide rehabilitative services
under this section, and nonresidential crisis stabilization services under section 256B.0624.

(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each recipient for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.

(c) The commissioner shall determine one rate for each provider that will bill
medical assistance for residential services under this section and one rate for each
deleted text begin nonresidential deleted text end new text begin assertive community treatment new text end provider. If a single entity provides both
services, one rate is established for the entity's residential services and another rate for the
entity's nonresidential services under this section. A provider is not eligible for payment
under this section without authorization from the commissioner. The commissioner shall
develop rates using the following criteria:

(1) deleted text begin the cost for similar services in the local trade area;
deleted text end

deleted text begin (2) deleted text end the provider's cost for services shall include direct services costs, other program
costs, and other costs determined as follows:

(i) the direct services costs must be determined using actual costs of salaries, benefits,
payroll taxes, and training of direct service staff and service-related transportation;

(ii) other program costs not included in item (i) must be determined as a specified
percentage of the direct services costs as determined by item (i). The percentage used shall
be determined by the commissioner based upon the average of percentages that represent
the relationship of other program costs to direct services costs among the entities that
provide similar services;

(iii) deleted text begin in situations where a provider of intensive residential services can demonstrate
actual program-related physical plant costs in excess of the group residential housing
reimbursement, the commissioner may include these costs in the program rate, so long
as the additional reimbursement does not subsidize the room and board expenses of the
program deleted text end new text begin physical plant costs calculated based on the percentage of space within the
program that is entirely devoted to treatment and programming. This does not include
administrative or residential space new text end ;

(iv) deleted text begin intensive nonresidential services deleted text end new text begin assertive community treatment new text end physical plant
costs must be reimbursed as part of the costs described in item (ii); and

(v) new text begin subject to federal approval, new text end up to an additional five percent of the total rate deleted text begin must deleted text end new text begin
may new text end be added to the program rate as a quality incentive based upon the entity meeting
performance criteria specified by the commissioner;

deleted text begin (3) deleted text end new text begin (2) new text end actual cost is defined as costs which are allowable, allocable, and reasonable,
and consistent with federal reimbursement requirements under Code of Federal
Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and Office of
Management and Budget Circular Number A-122, relating to nonprofit entities;

deleted text begin (4) deleted text end new text begin (3) new text end the number of service units;

deleted text begin (5) deleted text end new text begin (4) new text end the degree to which recipients will receive services other than services under
this section; new text begin and
new text end

deleted text begin (6) deleted text end new text begin (5) new text end the costs of other services that will be separately reimbursed deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (7) input from the local planning process authorized by the adult mental health
initiative under section 245.4661, regarding recipients' service needs.
deleted text end

(d) The rate for intensive rehabilitative mental health services must exclude room
and board, as defined in section 256I.03, subdivision 6, and services not covered under
this section, such as partial hospitalization, home care, and inpatient services.

new text begin (e) new text end Physician services that are not separately billed may be included in the rate to the
extent that a psychiatrist is a member of the treatment team. new text begin Physician services, whether
billed separately or included in the rate, may be delivered by telemedicine. For purposes
of this paragraph, "telemedicine" has the meaning given to "mental health telemedicine"
in section 256B.0625, subdivision 46, when telemedicine is used to provide intensive
residential treatment services.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end When services under this section are provided by an deleted text begin intensive nonresidential
service deleted text end new text begin assertive community treatment new text end provider, case management functions must be an
integral part of the team.

deleted text begin (f) deleted text end new text begin (g) new text end The rate for a provider must not exceed the rate charged by that provider for
the same service to other payors.

deleted text begin (g) deleted text end new text begin (h) new text end The rates for existing programs must be established prospectively based upon
the expenditures and utilization over a prior 12-month period using the criteria established
in paragraph (c). new text begin The rates for new programs must be established based upon estimated
expenditures and estimated utilization using the criteria established in paragraph (c).
new text end

deleted text begin (h) deleted text end new text begin (i) new text end Entities who discontinue providing services must be subject to a settle-up
process whereby actual costs and reimbursement for the previous 12 months are
compared. In the event that the entity was paid more than the entity's actual costs plus
any applicable performance-related funding due the provider, the excess payment must
be reimbursed to the department. If a provider's revenue is less than actual allowed costs
due to lower utilization than projected, the commissioner may reimburse the provider to
recover its actual allowable costs. The resulting adjustments by the commissioner must
be proportional to the percent of total units of service reimbursed by the commissioner new text begin
and must reflect a difference of greater than five percent new text end .

deleted text begin (i) deleted text end new text begin (j) new text end A provider may request of the commissioner a review of any rate-setting
decision made under this subdivision.

Subd. 9.

Provider enrollment; rate setting for county-operated entities.

Counties
that employ their own staff to provide services under this section shall apply directly to
the commissioner for enrollment and rate setting. In this case, a county contract is not
required deleted text begin and the commissioner shall perform the program review and rate setting duties
which would otherwise be required of counties under this section deleted text end .

Subd. 10.

Provider enrollment; rate setting for specialized program.

A new text begin county
contract is not required for a new text end provider proposing to serve a subpopulation of eligible
recipients deleted text begin may bypass the county approval procedures in this section and receive approval
for provider enrollment and rate setting directly from the commissioner deleted text end under the
following circumstances:

(1) the provider demonstrates that the subpopulation to be served requires a
specialized program which is not available from county-approved entities; and

(2) the subpopulation to be served is of such a low incidence that it is not feasible to
develop a program serving a single county or regional group of counties.

deleted text begin For providers meeting the criteria in clauses (1) and (2), the commissioner shall
perform the program review and rate setting duties which would otherwise be required of
counties under this section.
deleted text end

new text begin Subd. 11. new text end

new text begin Sustainability grants. new text end

new text begin The commissioner may disburse grant funds
directly to intensive residential services providers and assertive community treatment
providers to maintain access to these services.
new text end

Sec. 3.

Minnesota Statutes 2014, section 256B.0624, subdivision 7, is amended to read:

Subd. 7.

Crisis stabilization services.

(a) Crisis stabilization services must be
provided by qualified staff of a crisis stabilization services provider entity and must meet
the following standards:

(1) a crisis stabilization treatment plan must be developed which meets the criteria
in subdivision 11;

(2) staff must be qualified as defined in subdivision 8; and

(3) services must be delivered according to the treatment plan and include
face-to-face contact with the recipient by qualified staff for further assessment, help with
referrals, updating of the crisis stabilization treatment plan, supportive counseling, skills
training, and collaboration with other service providers in the community.

(b) If crisis stabilization services are provided in a supervised, licensed residential
setting, the recipient must be contacted face-to-face daily by a qualified mental health
practitioner or mental health professional. The program must have 24-hour-a-day
residential staffing which may include staff who do not meet the qualifications in
subdivision 8. The residential staff must have 24-hour-a-day immediate direct or telephone
access to a qualified mental health professional or practitioner.

(c) If crisis stabilization services are provided in a supervised, licensed residential
setting that serves no more than four adult residents, and deleted text begin no more than two are recipients
of crisis stabilization services deleted text end new text begin one or more individuals are present at the setting to receive
residential crisis stabilization services new text end , the residential staff must include, for at least eight
hours per day, at least one individual who meets the qualifications in subdivision 8 new text begin ,
paragraph (a), clause (1) or (2) new text end .

(d) If crisis stabilization services are provided in a supervised, licensed residential
setting that serves more than four adult residents, and one or more are recipients of crisis
stabilization services, the residential staff must include, for 24 hours a day, at least one
individual who meets the qualifications in subdivision 8. During the first 48 hours that a
recipient is in the residential program, the residential program must have at least two staff
working 24 hours a day. Staffing levels may be adjusted thereafter according to the needs
of the recipient as specified in the crisis stabilization treatment plan.

Sec. 4. new text begin RATE-SETTING METHODOLOGY FOR COMMUNITY-BASED
MENTAL HEALTH SERVICES.
new text end

new text begin The commissioner of human services shall conduct a comprehensive analysis
of the current rate-setting methodology for all community-based mental health
services for children and adults. The report shall include an assessment of alternative
payment structures, consistent with the intent and direction of the federal Centers for
Medicare and Medicaid Services, that could provide adequate reimbursement to sustain
community-based mental health services regardless of geographic location. The report
shall also include recommendations for establishing pay-for-performance measures for
providers delivering services consistent with evidence-based practices. In developing the
report, the commissioner shall consult with stakeholders and with outside experts in
Medicaid financing. The commissioner shall provide a report on the analysis to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
and human services finance by January 1, 2017.
new text end

Sec. 5. new text begin EXCELLENCE IN MENTAL HEALTH DEMONSTRATION PROJECT.
new text end

new text begin By January 15, 2016, the commissioner of human services shall report to the
legislative committees with jurisdiction over human services issues on the progress
of the Excellence in Mental Health demonstration project under Minnesota Statutes,
section 245.735. The commissioner shall include in the report any recommendations
for legislative changes needed to implement the reform projects specified in Minnesota
Statutes, section 245.735, subdivision 4.
new text end

Sec. 6. new text begin APPROPRIATIONS.
new text end

new text begin (a) $282,000 in fiscal year 2016 and $565,000 in fiscal year 2017 are appropriated
from the general fund to the commissioner of human services for respite care programs for
families of children with serious mental illnesses.
new text end

new text begin (b) $118,000 in fiscal year 2016 and $236,000 in fiscal year 2017 are appropriated
from the general fund to the commissioner of human services to establish a psychiatric
residency position.
new text end

new text begin (c) $922,000 in fiscal year 2017 is appropriated from the general fund to the
commissioner of human services for grants to mental health agencies with expertise in
early childhood mental health to provide mental health consultation in child care agencies.
new text end