Minnesota Legislature
HF 3445
1st Engrossment - 91st Legislature (2019 - 2020) Posted on 03/04/2020 04:43pm
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A bill for an act
relating to human services; eliminating requirement to involve state medical review
agent in determination and documentation of medically necessary psychiatric
residential treatment facility services; requiring establishment of per diem rate per
provider of youth psychiatric residential treatment services; permitting facilities
or licensed professionals to submit billing for arranged services; amending
Minnesota Statutes 2018, section 256B.0941, subdivisions 1, 3.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2018, section 256B.0941, subdivision 1, is amended to read:
Subdivision 1.
Eligibility.
(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:
(1) before admission, services are determined to be medically necessary deleted text begin by the state's
medical review agentdeleted text end according to Code of Federal Regulations, title 42, section 441.152;
(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;
(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;
(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;
(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;
(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and
(7) was referred for treatment in a psychiatric residential treatment facility by a qualified
mental health professional licensed as defined in section 245.4871, subdivision 27, clauses
(1) to (6).
deleted text begin
(b) A mental health professional making a referral shall submit documentation to the
state's medical review agent containing all information necessary to determine medical
necessity, including a standard diagnostic assessment completed within 180 days of the
individual's admission. Documentation shall include evidence of family participation in the
individual's treatment planning and signed consent for services.
deleted text end
new text begin
(b) The commissioner shall provide oversight and conduct utilization reviews of referrals
to and admitted clients in psychiatric residential treatment facilities to ensure that eligibility
criteria, clinical services, and treatment planning are reflective of clinical, state, and federal
standards for psychiatric residential treatment facility level of care. The commissioner shall
coordinate a statewide list of children and youth who meet the medical necessity criteria
for psychiatric residential treatment facility level of care and who are awaiting admission.
The statewide list must not be used to direct admission of children and youth in specific
facilities.
new text end
Sec. 2.
Minnesota Statutes 2018, section 256B.0941, subdivision 3, is amended to read:
Subd. 3.
Per diem rate.
(a) The commissioner deleted text begin shalldeleted text end new text begin mustnew text end establish deleted text begin a statewidedeleted text end new text begin onenew text end per
diem rate new text begin per provider new text end for psychiatric residential treatment facility services for individuals
21 years of age or younger. The rate for a provider must not exceed the rate charged by that
provider for the same service to other payers. Payment must not be made to more than one
entity for each individual for services provided under this section on a given day. The
commissioner deleted text begin shalldeleted text end new text begin mustnew text end set rates prospectively for the annual rate period. The commissioner
deleted text begin shalldeleted text end new text begin mustnew text end require providers to submit annual cost reports on a uniform cost reporting form
and deleted text begin shalldeleted text end new text begin mustnew text end use submitted cost reports to inform the rate-setting process. The cost reporting
deleted text begin shalldeleted text end new text begin mustnew text end be done according to federal requirements for Medicare cost reports.
(b) The following are included in the rate:
(1) costs necessary for licensure and accreditation, meeting all staffing standards for
participation, meeting all service standards for participation, meeting all requirements for
active treatment, maintaining medical records, conducting utilization review, meeting
inspection of care, and discharge planning. The direct services costs must be determined
using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff
and service-related transportation; and
(2) payment for room and board provided by facilities meeting all accreditation and
licensing requirements for participation.
(c) A facility may submit a claim for payment outside of the per diem for professional
services arranged by and provided at the facility by an appropriately licensed professional
who is enrolled as a provider with Minnesota health care programs. Arranged services deleted text begin must
be billed by the facility on a separate claim, and the facility shall be responsible for payment
to the providerdeleted text end new text begin may be billed by either the facility or the licensed professionalnew text end . These services
must be included in the individual plan of care and are subject to prior authorization deleted text begin by the
state's medical review agentdeleted text end .
(d) Medicaid deleted text begin shalldeleted text end new text begin mustnew text end reimburse for concurrent services as approved by the
commissioner to support continuity of care and successful discharge from the facility.
"Concurrent services" means services provided by another entity or provider while the
individual is admitted to a psychiatric residential treatment facility. Payment for concurrent
services may be limited and these services are subject to prior authorization by the state's
medical review agent. Concurrent services may include targeted case management, assertive
community treatment, clinical care consultation, team consultation, and treatment planning.
(e) Payment rates under this subdivision deleted text begin shalldeleted text end new text begin mustnew text end not include the costs of providing
the following services:
(1) educational services;
(2) acute medical care or specialty services for other medical conditions;
(3) dental services; and
(4) pharmacy drug costs.
(f) For purposes of this section, "actual cost" means costs that are allowable, allocable,
reasonable, and consistent with federal reimbursement requirements in Code of Federal
Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of
Management and Budget Circular Number A-122, relating to nonprofit entities.