HF 3818

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; expanding reimbursement for mental health services;
amending Minnesota Statutes 2004, sections 256B.0623, subdivision 8;
256B.0625, subdivision 43, by adding a subdivision; 256B.0943, subdivisions
1, 2, by adding a subdivision; 256B.761; Minnesota Statutes 2005 Supplement,
sections 256B.0625, subdivisions 38, 46; 256L.035; proposing coding for new
law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2004, section 256B.0623, subdivision 8, is amended to
read:

Subd. 8.

Diagnostic assessment.

Providers of adult rehabilitative mental health
services must complete a diagnostic assessment as defined in section 245.462, subdivision
9, within five days after the recipient's second visit or within 30 days after intake,
whichever occurs first. new text begin A diagnostic assessment must be reimbursed at the same rate
as a diagnostic assessment under section 256B.49, subdivision 14. new text end In cases where a
diagnostic assessment is available that reflects the recipient's current status, and has been
completed within 180 days preceding admission, an update must be completed. An
update shall include a written summary by a mental health professional of the recipient's
current mental health status and service needs. If the recipient's mental health status
has changed significantly since the adult's most recent diagnostic assessment, a new
diagnostic assessment is required. For initial implementation of adult rehabilitative mental
health services, until June 30, 2005, a diagnostic assessment that reflects the recipient's
current status and has been completed within the past three years preceding admission
is acceptable.

Sec. 2.

Minnesota Statutes 2005 Supplement, section 256B.0625, subdivision 38,
is amended to read:

Subd. 38.

Payments for mental health services.

new text begin (a) new text end Payments for mental
health services covered under the medical assistance program that are provided by
masters-prepared mental health professionals shall be 80 percent of the rate paid to
doctoral-prepared professionals. Payments for mental health services covered under
the medical assistance program that are provided by masters-prepared mental health
professionals employed by community mental health centers shall be 100 percent of the
rate paid to doctoral-prepared professionals. deleted text begin For purposes of reimbursement of mental
health professionals under the medical assistance program, all
deleted text end

new text begin (b) Payments for mental health services covered under the medical assistance
program that are provided by new text end social workers who:

(1) have received a master's degree in social work from a program accredited by the
Council on Social Work Education;

(2) are licensed at the level of graduate social worker or independent social worker;
deleted text begin and
deleted text end

(3) are practicing clinical social work under appropriate supervision, as defined by
chapter 148D; new text begin and
new text end

new text begin (4) new text end meet all requirements under Minnesota Rules, part 9505.0323, subpart 24, deleted text begin and
shall be paid accordingly
deleted text end

new text begin shall be paid in accordance with Minnesota Rules, part 9505.0323, subpart 24, unless
paragraph (c) is applicable new text end .

new text begin (c) Payments for mental health services covered under the medical assistance
program that are provided by an individual who is employed by a community health
center and who has completed all requirements for licensure or board certification as a
mental health professional except for the requirements for supervised experience in the
delivery of mental health services or by an individual who is a student in a bona fide field
placement or internship under a program leading to completion of the requirements for
licensure as a mental health professional shall be reimbursed at 100 percent of the rate
paid to a doctoral-prepared professional. The individual providing the service must be
under the clinical supervision of a fully qualified mental health professional.
new text end

new text begin (d) Medical assistance covers clinical supervision of unlicensed practitioners by a
mental health professional when clinical supervision is required as part of other medical
assistance services.
new text end

Sec. 3.

Minnesota Statutes 2004, section 256B.0625, subdivision 43, is amended to
read:

Subd. 43.

Mental health provider travel time.

Medical assistance covers provider
travel time new text begin plus reimbursement for mileage new text end if a recipient's individual treatment plan
requires the provision of mental health services outside of the provider's normal place of
business. deleted text begin This deleted text end new text begin Reimbursement under this subdivision new text end does not include any travel time
which is included in other billable services, and is only covered when the mental health
service being provided to a recipient is covered under medical assistance.

Sec. 4.

Minnesota Statutes 2005 Supplement, section 256B.0625, subdivision 46,
is amended to read:

Subd. 46.

Mental health telemedicine.

Effective January 1, 2006, and subject to
federal approval, mental health services that are otherwise covered by medical assistance
as direct face-to-face services may be provided via two-way interactive video. Use of
two-way interactive video must be medically appropriate to the condition and needs
of the person being served. Reimbursement is at the same rates and under the same
conditions that would otherwise apply to the service new text begin and shall include payment for the
originating facility fee and the cost of broadband connections new text end . The interactive video
equipment and connection must comply with Medicare standards in effect at the time
the service is provided.

Sec. 5.

Minnesota Statutes 2004, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 5l. new text end

new text begin Intensive mental health outpatient treatment. new text end

new text begin Intensive outpatient
treatment is a concentrated, nonresidential, coordinated, structured, multimode treatment
and rehabilitative service that is at least two hours per day, and nine to 20 hours per
week, designed to address a mental disorder as indicated in the treatment plan. The
service provides an opportunity to combine existing covered services, in order to
deliver the necessary intensity and frequency of individual, family or multifamily group
psychotherapy, psycho-educational services, and adjunctive services such as medical
monitoring, family psycho-education, behavioral parent training, rehabilitative services,
medication education, relapse prevention, illness management and recovery services,
care coordination, and service coordination and referral arrangements for medical care
or social services necessary to support the individual treatment plan. During transition
into or from services, intensive outpatient treatment may include time-limited services in
multiple settings as clinically necessary. The service must be paid as a per diem based on
90 percent of the rate paid for partial hospitalization. Eligible providers must be licensed
or certified to provide all aspects of the service.
new text end

Sec. 6.

Minnesota Statutes 2004, 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. 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) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.

(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 program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.

(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11.

(h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history 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, maintaining clinical records, consulting with others
about the client's mental health status, preparing reports, receiving clinical supervision
directly related to the client's psychotherapy session, and revising the client's individual
treatment plan.

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

new text begin (k) "Family psycho-education" is a multimodel outpatient therapy and rehabilitative
service that involves parents, families, and others as resources in the treatment, recovery,
and improved functioning of a person with mental illness or emotional disturbance,
in which families learn about the illness, family reactions, and types of treatment and
supports. Families learn to develop skills to handle problems posed by mental illness
including coping, managing stress, ensuring safety, creating social support, identifying
resources, and supporting treatment and recovery goals. Services include family
counseling, family treatment planning, and family support using cognitive, behavioral,
problem-solving, and communication strategies, and may involve individual, family, and
group intervention activities for consumers and families together, famlies-only, or brief or
intermittent consultations at critical times in an episode of care. Eligible providers must
be certified to provide both outpatient mental health services and rehabilitative services
under sections 256B.0623 and 256B.0943.
new text end

deleted text begin (k) deleted text end new text begin (l) new text end "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.

deleted text begin (l) deleted text end new text begin (m) new text end "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21.

deleted text begin (m) deleted text end new text begin (n) new text end "Mental health professional" means an individual as defined in section
245.4871, subdivision 27, clauses (1) to (5), or tribal vendor as defined in section 256B.02,
subdivision 7, paragraph (b).

deleted text begin (n) deleted text end new text begin (o) new text end "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.

deleted text begin (o) deleted text end new text begin (p) new text end "Skills training" means individual, family, or group training designed to
improve the basic functioning of the child with emotional disturbance and the child's
family in the activities of daily living and community living, and to improve the social
functioning of the child and the child's family in areas important to the child's maintaining
or reestablishing residency in the community. new text begin Skills training must also be provided to the
parent, guardian, or caregiver of a child without the child present. new text end Individual, family,
and group skills training must:

(1) consist of activities designed to promote skill development of the child and the
child's family in the use of age-appropriate daily living skills, interpersonal and family
relationships, and leisure and recreational services;

(2) consist of activities that will assist the family's understanding of normal child
development and to use parenting skills that will help the child with emotional disturbance
achieve the goals outlined in the child's individual treatment plan; and

(3) promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance.

Sec. 7.

Minnesota Statutes 2004, section 256B.0943, subdivision 2, is amended to read:

Subd. 2.

Covered service components of children's therapeutic services and
supports.

(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports as defined in this section that an eligible
provider entity under subdivisions 4 and 5 provides to a client eligible under subdivision 3.

(b) The service components of children's therapeutic services and supports are:

(1) individual, family, deleted text begin and deleted text end group psychotherapy new text begin , and family psycho-education new text end ;

(2) individual, family, or group skills training provided by a mental health
professional or mental health practitioner;

(3) crisis assistance;

(4) mental health behavioral aide services; and

(5) direction of a mental health behavioral aide.

(c) Service components may be combined to constitute therapeutic programs,
including day treatment programs and preschool programs. Although day treatment and
preschool programs have specific client and provider eligibility requirements, medical
assistance only pays for the service components listed in paragraph (b).

Sec. 8.

Minnesota Statutes 2004, section 256B.0943, is amended by adding a
subdivision to read:

new text begin Subd. 11a. new text end

new text begin Reimbursement of diagnostic assessments. new text end

new text begin A diagnostic assessment
under this section must be reimbursed at the same rate as a diagnostic assessment under
section 256B.49, subdivision 14.
new text end

Sec. 9.

Minnesota Statutes 2004, section 256B.761, is amended to read:

256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day
treatment services, home-based mental health services, and family community support
services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
50th percentile of 1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
1993, with at least 33 percent of the clients receiving rehabilitation services in the most
recent calendar year who are medical assistance recipients, will be increased by 38 percent,
when those services are provided within the comprehensive outpatient rehabilitation
facility and provided to residents of nursing facilities owned by the entity.

new text begin (c) Notwithstanding section 256B.03, subdivision 1, effective July 1, 2006, the
medical assistance payment rates for mental health services provided by mental health
professionals shall be determined by using the average usual and customary charge of
the doctoral prepared professionals only.
new text end

Sec. 10.

new text begin [256B.763] MENTAL HEALTH CENTERS AND CLINICS
REIMBURSEMENT.
new text end

new text begin (a) Effective for services rendered on or after July 1, 2006, payment rates for: (1)
community mental health center services under section 256B.0625, subdivision 5; and (2)
services provided by mental health clinics and centers certified under Minnesota Rules,
parts 9520.0750 to 9520.0870, or hospital outpatient psychiatric departments that are
designated as essential community providers under section 62Q.19, shall be increased by
20 percent over the rates in effect on January 1, 2005. This increase does not apply to
services with rates negotiated with the county or that received increases between January
1, 2005, and January 1, 2006. This reimbursement increase shall be in addition to any
other reimbursement increases enacted by the 2006 legislature.
new text end

new text begin (b) The commissioner shall adjust rates paid to prepaid health plans under contract
with the commissioner to reflect the rate increases provided in paragraph (a) effective for
services rendered on or after January 1, 2007. The prepaid health plan must pass this rate
increase to the providers identified in paragraph (a).
new text end

Sec. 11.

Minnesota Statutes 2005 Supplement, section 256L.035, is amended to read:

256L.035 LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE
ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.

(a) "Covered health services" for individuals under section 256L.04, subdivision
7, with income above 75 percent, but not exceeding 175 percent, of the federal poverty
guideline means:

(1) inpatient hospitalization benefits with a ten percent co-payment up to $1,000 and
subject to an annual limitation of $10,000;

(2) physician services provided during an inpatient stay; and

(3) physician services not provided during an inpatient stay; outpatient hospital
services; freestanding ambulatory surgical center services; chiropractic services; lab and
diagnostic services; diabetic supplies and equipment; new text begin outpatient mental health services,
as defined under section 256L.03, subdivision 1; new text end and prescription drugs; subject to the
following co-payments:

(i) $50 co-pay per emergency room visit;

(ii) $3 co-pay per prescription drug; and

(iii) $5 co-pay per nonpreventive visit.

The services covered under this section may be provided by a physician, physician
ancillary, chiropractor, deleted text begin psychologist, or licensed independent clinical social worker deleted text end new text begin or a
mental health professional, as defined under section 256B.0625, subdivision 42, new text end if the
services are within the scope of practice of that health care professional.

For purposes of this section, "a visit" means an episode of service which is required
because of a recipient's symptoms, diagnosis, or established illness, and which is delivered
in an ambulatory setting by any health care provider identified in this paragraph.

Enrollees are responsible for all co-payments in this section.

(b) Reimbursement to the providers shall be reduced by the amount of the
co-payment, except that reimbursement for prescription drugs shall not be reduced once a
recipient has reached the $20 per month maximum for prescription drug co-payments.
The provider collects the co-payment from the recipient. Providers may not deny services
to recipients who are unable to pay the co-payment, except as provided in paragraph (c).

(c) If it is the routine business practice of a provider to refuse service to an individual
with uncollected debt, the provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient with uncollected debt before
services can be denied.