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HF 1706

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/13/2023 01:07pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; modifying telehealth requirements; increasing medical
assistance reimbursement for protected transport services; establishing grants;
appropriating money; amending Minnesota Statutes 2022, sections 62A.673,
subdivisions 2, 5, 6; 256B.0625, subdivision 17.

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

Section 1.

Minnesota Statutes 2022, section 62A.673, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(b) "Distant site" means a site at which a health care provider is located while providing
health care services or consultations by means of telehealth.

(c) "Health care provider" means a health care professional who is licensed or registered
by the state to perform health care services within the provider's scope of practice and in
accordance with state law. A health care provider includes a mental health professional
under section 245I.04, subdivision 2; a mental health practitioner under section 245I.04,
subdivision 4
; a clinical trainee under section 245I.04, subdivision 6; a treatment coordinator
under section 245G.11, subdivision 7; an alcohol and drug counselor under section 245G.11,
subdivision 5
; and a recovery peer under section 245G.11, subdivision 8.

(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.

(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan
includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental
plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed
to pay benefits directly to the policy holder.

(f) "Originating site" means a site at which a patient is located at the time health care
services are provided to the patient by means of telehealth. For purposes of store-and-forward
deleted text begin technologydeleted text end new text begin transfernew text end , the originating site also means the location at which a health care
provider transfers or transmits information to the distant site.

(g) "Store-and-forward technology" means the new text begin technology that enables new text end asynchronous
electronic transfer or transmission of a patient's medical information or data from an
originating site to a distant site for the purposes of diagnostic and therapeutic assistance in
the care of a patient.

(h) "Telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual new text begin or audio-only new text end communications to
provide or support health care delivery and facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care. Telehealth includes
the application of secure video conferencing, store-and-forward technology, and synchronous
interactions between a patient located at an originating site and a health care provider located
at a distant site. deleted text begin Until July 1, 2023,deleted text end Telehealth also includes audio-only communication
between a health care provider and a patient deleted text begin in accordance with subdivision 6, paragraph
(b)
deleted text end new text begin if the communication is a scheduled appointment and the standard of care for the service
can be met through the use of audio-only communication
new text end . Telehealth does not include
communication between health care providers that consists solely of a telephone conversation,
email, or facsimile transmission. Telehealth does not include communication between a
health care provider and a patient that consists solely of an email or facsimile transmission.
Telehealth does not include telemonitoring services as defined in paragraph (i).

(i) "Telemonitoring services" means the remote monitoring of clinical data related to
the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits
the data electronically to a health care provider for analysis. Telemonitoring is intended to
collect an enrollee's health-related data for the purpose of assisting a health care provider
in assessing and monitoring the enrollee's medical condition or status.

Sec. 2.

Minnesota Statutes 2022, section 62A.673, subdivision 5, is amended to read:


Subd. 5.

Reimbursement for services delivered through telehealth.

(a) A health carrier
must reimburse the health care provider for services delivered through telehealth on the
same basis and at the same rate as the health carrier would apply to those services if the
services had been delivered by the health care provider through in-person contact.

(b) A health carrier must not deny or limit reimbursement based solely on a health care
provider delivering the service or consultation through telehealth instead of through in-person
contact.

(c) A health carrier must not deny or limit reimbursement based solely on the technology
and equipment used by the health care provider to deliver the health care service or
consultation through telehealth, provided the technology and equipment used by the provider
meets the requirements of this section and is appropriate for the particular service.

deleted text begin (d) Nothing in this subdivision prohibits a health carrier and health care provider from
entering into a contract that includes a value-based reimbursement arrangement for the
delivery of covered services that may include services delivered through telehealth, and
such an arrangement shall not be considered a violation of this subdivision.
deleted text end

Sec. 3.

Minnesota Statutes 2022, section 62A.673, subdivision 6, is amended to read:


Subd. 6.

Telehealth equipment.

(a) A health carrier must not require a health care
provider to use specific telecommunications technology and equipment as a condition of
coverage under this section, provided the health care provider uses telecommunications
technology and equipment that complies with current industry interoperable standards and
complies with standards required under the federal Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, and regulations promulgated under that
Act, unless authorized under this section.

(b) A health carrier must provide coverage for health care services delivered through
telehealth by means of the use of audio-only communication if the communication is a
scheduled appointment and the standard of care for that particular service can be met through
the use of audio-only communication. deleted text begin Substance use disorder treatment services and mental
health care services delivered through telehealth by means of audio-only communication
may be covered without a scheduled appointment if the communication was initiated by
the enrollee while in an emergency or crisis situation and a scheduled appointment was not
possible due to the need of an immediate response. This paragraph expires July 1, 2023.
deleted text end

new text begin (c) Notwithstanding paragraph (b), substance use disorder treatment services and mental
health care services delivered through telehealth by means of audio-only communication
may be covered without a scheduled appointment if the communication was initiated by
the enrollee while in an emergency or crisis situation and a scheduled appointment was not
possible due to the need for an immediate response.
new text end

Sec. 4.

Minnesota Statutes 2022, section 256B.0625, subdivision 17, is amended to read:


Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transit, as defined in section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472,
subdivision 1, paragraph (h).

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.

(d) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(e) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.

(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).

(g) The commissioner may use an order by the recipient's attending physician, advanced
practice registered nurse, physician assistant, or a medical or mental health professional to
certify that the recipient requires nonemergency medical transportation services.
Nonemergency medical transportation providers shall perform driver-assisted services for
eligible individuals, when appropriate. Driver-assisted service includes passenger pickup
at and return to the individual's residence or place of business, assistance with admittance
of the individual to the medical facility, and assistance in passenger securement or in securing
of wheelchairs, child seats, or stretchers in the vehicle.

Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.

Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

(h) The administrative agency shall use the level of service process established by the
commissioner to determine the client's most appropriate mode of transportation. If public
transit or a certified transportation provider is not available to provide the appropriate service
mode for the client, the client may receive a onetime service upgrade.

(i) The covered modes of transportation are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.

(k) The commissioner shall:

(1) verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.

(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:

(1) $0.22 per mile for client reimbursement;

(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;

(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;

(4) $13 for the base rate and $1.30 per mile for assisted transport;

(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;

(6) $75 for the base rate new text begin for the first 100 miles and an additional $75 for trips over 100
miles,
new text end and $2.40 per mile for protected transport; and

(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.

(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:

(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and

(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).

(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.

(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.

(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).

Sec. 5. new text begin APPROPRIATIONS; CHILDREN'S FIRST EPISODE OF PSYCHOSIS.
new text end

new text begin (a) $960,000 in fiscal year 2024 and $960,000 in fiscal year 2025 are appropriated from
the general fund to the commissioner of human services to implement a children's first
episode of psychosis grant under Minnesota Statutes, section 245.4905.
new text end

new text begin (b) Of these appropriations, $841,000 in fiscal year 2024 and $841,000 in fiscal year
2025 are for grants for children's first episode of psychosis.
new text end

new text begin (c) Of these appropriations, $119,000 in fiscal year 2024 and $119,000 in fiscal year
2025 are for administration.
new text end

Sec. 6. new text begin APPROPRIATIONS; HOUSING FOR ADULTS WITH SERIOUS MENTAL
ILLNESS.
new text end

new text begin $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the general
fund to the commissioner of human services for adult mental health grants under Minnesota
Statutes, section 245.4661, subdivision 9, paragraph (a), clause (2), to support increased
availability of housing options with supports for persons with serious mental illness.
new text end

Sec. 7. new text begin APPROPRIATIONS; PROTECTED TRANSPORT START-UP GRANTS.
new text end

new text begin $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the general
fund to the commissioner of human services to provide start-up grants to nonemergency
medical transportation providers to configure vehicles to meet protected transport
requirements.
new text end

Sec. 8. new text begin APPROPRIATIONS; ENGAGEMENT SERVICES PILOT GRANTS.
new text end

new text begin $750,000 in fiscal year 2024 and $750,000 in fiscal year 2025 are appropriated from the
general fund to the commissioner of human services for grants to counties to establish pilot
projects to provide engagement services under Minnesota Statutes, section 253B.041.
Counties receiving grants must develop a system to respond to individual requests for
engagement services, conduct outreach to families and engagement services providers, and
evaluate the impact of engagement services in decreasing civil commitments, increasing
engagement in treatment, decreasing police involvement with individuals exhibiting
symptoms of serious mental illness, and other measures.
new text end

Sec. 9. new text begin APPROPRIATIONS; BEHAVIORAL HEALTH NAVIGATION PORTAL
GRANT.
new text end

new text begin $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the general
fund to the commissioner of human services for a competitive grant to an entity to establish
an online mental health and substance use disorder resource and referral information exchange
service to be called the behavioral health navigation portal. The commissioner shall develop
and issue a request for proposals and award a grant to a single recipient to develop the portal
that will function as an open source communication hub and self-referral tool that publishes
real-time availability for mental health and substance use disorder treatment services
statewide. Grant funds must be used to establish and maintain the portal, which must:
new text end

new text begin (1) provide an open access, single point of entry;
new text end

new text begin (2) contain password-protected, secure tools that enable service providers to define,
maintain, and update service and availability information and conduct treatment and discharge
planning;
new text end

new text begin (3) provide regularly updated, real-time, accurate, date-stamped, searchable, and
transparent information to individuals searching the portal. Publicly searchable provider
information must include:
new text end

new text begin (i) health insurance carrier acceptance;
new text end

new text begin (ii) location;
new text end

new text begin (iii) regularly maintained availability and opening information;
new text end

new text begin (iv) community supports access points and information;
new text end

new text begin (v) educational and public information resources; and
new text end

new text begin (vi) service provider contact information;
new text end

new text begin (4) include a communications hub to facilitate provider collaboration; and
new text end

new text begin (5) incorporate data collection tools and archival reporting to inform and measure public
access system information, openings, responsibility, parity enforcement, service gaps, and
system investment priorities.
new text end