HF 4149

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/13/2024 12:19pm

A bill for an act
relating to behavioral health; modifying education requirements for licensure;
modifying definition of accrediting body; modifying behavioral health licensing
and eligibility; modifying paperwork reduction report date; amending Minnesota
Statutes 2022, sections 148F.025, subdivision 2; 245G.031, subdivision 2;
Minnesota Statutes 2023 Supplement, sections 245G.11, subdivision 10; 254B.04,
subdivision 6; 254B.05, subdivision 5; Laws 2021, First Special Session chapter
7, article 11, section 38, as amended.

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

Section 1.

Minnesota Statutes 2022, section 148F.025, subdivision 2, is amended to read:

Subd. 2.

Education requirements for licensure.

An applicant for licensure must submit
evidence satisfactory to the board that the applicant has:

(1) received a bachelor's new text begin or master's new text end degree from an accredited school or educational
program; and

(2) received 18 semester credits or 270 clock hours of academic course work and 880
clock hours of supervised alcohol and drug counseling practicum from an accredited school
or education program. The course work and practicum do not have to be part of the bachelor's
degree earned under clause (1). The academic course work must be in the following areas:

(i) an overview of the transdisciplinary foundations of alcohol and drug counseling,
including theories of chemical dependency, the continuum of care, and the process of change;

(ii) pharmacology of substance abuse disorders and the dynamics of addiction, including
substance use disorder treatment with medications for opioid use disorder;

(iii) professional and ethical responsibilities;

(iv) multicultural aspects of chemical dependency;

(v) co-occurring disorders; and

(vi) the core functions defined in section 148F.01, subdivision 10.

Sec. 2.

Minnesota Statutes 2022, section 245G.031, subdivision 2, is amended to read:

Subd. 2.

Qualifying accreditation; determination of same and similar standards.

(a)
The commissioner must accept a qualifying accreditation from an accrediting body listed
in paragraph (c) after determining, in consultation with the accrediting body and license
holders, the accrediting body's standards that are the same as or similar to the licensing
requirements in this chapter. In determining whether standards of an accrediting body are
the same as or similar to licensing requirements under this chapter, the commissioner shall
give due consideration to the existence of a standard that aligns in whole or in part to a
licensing standard.

(b) Upon request by a license holder, the commissioner may allow the accrediting body
to monitor for compliance with licensing requirements under this chapter that are determined
to be neither the same as nor similar to those of the accrediting body.

(c) For purposes of this section, "accrediting body" means the joint commission new text begin , the
Commission on Accreditation of Rehabilitation Facilities, or the ASAM Level of Care
Certification Program new text end .

(d) Qualifying accreditation only applies to the license holder's licensed programs that
are included in the accrediting body's survey during each survey period.

Sec. 3.

Minnesota Statutes 2023 Supplement, section 245G.11, subdivision 10, is amended
to read:

Subd. 10.

Student interns and former students.

(a) A qualified staff member must
supervise and be responsible for a treatment service performed by a student intern and must
review and sign each assessment, individual treatment plan, and treatment plan review
prepared by a student intern.

(b) An alcohol and drug counselor must supervise and be responsible for a treatment
service performed by a former student and must review and sign each assessment, individual
treatment plan, and treatment plan review prepared by the former student.

(c) A student intern or former student must receive the orientation and training required
in section 245G.13, subdivisions 1, clause (7), and 2. No more than 50 percent of the
treatment staff may be students deleted text begin , deleted text end new text begin or new text end former students deleted text begin , or licensing candidates deleted text end with time
documented to be directly related to the provision of treatment services for which the staff
are authorized.

Sec. 4.

Minnesota Statutes 2023 Supplement, section 254B.04, subdivision 6, is amended
to read:

Subd. 6.

Local agency to determine client financial eligibility.

(a) The local agency
shall determine a client's financial eligibility for the behavioral health fund according to
section 254B.04, subdivision 1a, with the income calculated prospectively for one year from
the date of comprehensive assessment. The local agency shall pay for eligible clients
according to chapter 256G. The local agency shall enter the financial eligibility span within
deleted text begin ten deleted text end new text begin five new text end deleted text begin calendar deleted text end new text begin business new text end days of request. Client eligibility must be determined using forms
prescribed by the department. To determine a client's eligibility, the local agency must
determine the client's income, the size of the client's household, the availability of a
third-party payment source, and a responsible relative's ability to pay for the client's substance
use disorder treatment. new text begin The eligibility span must begin from the date of the comprehensive
assessment or the date the services were initiated if the assessment was completed within
the required timelines of chapter 245G. An affidavit alone is proof or verification of
behavioral health fund eligibility and no further documentation is required unless there is
probable cause to show that the client may not meet eligibility requirements.
new text end

(b) A client who is a minor child must not be deemed to have income available to pay
for substance use disorder treatment, unless the minor child is responsible for payment under
section 144.347 for substance use disorder treatment services sought under section 144.343,
subdivision 1.

(c) The local agency must determine the client's household size as follows:

(1) if the client is a minor child, the household size includes the following persons living
in the same dwelling unit:

(i) the client;

(ii) the client's birth or adoptive parents; and

(iii) the client's siblings who are minors; and

(2) if the client is an adult, the household size includes the following persons living in
the same dwelling unit:

(i) the client;

(ii) the client's spouse;

(iii) the client's minor children; and

(iv) the client's spouse's minor children.

For purposes of this paragraph, household size includes a person listed in clauses (1) and
(2) who is in an out-of-home placement if a person listed in clause (1) or (2) is contributing
to the cost of care of the person in out-of-home placement.

(d) The local agency must determine the client's current prepaid health plan enrollment,
the availability of a third-party payment source, including the availability of total payment,
partial payment, and amount of co-payment.

(e) The local agency must provide the required eligibility information to the department
in the manner specified by the department.

(f) The local agency shall require the client and policyholder to conditionally assign to
the department the client and policyholder's rights and the rights of minor children to benefits
or services provided to the client if the department is required to collect from a third-party
pay source.

(g) The local agency must redetermine a client's eligibility for the behavioral health fund
every 12 months.

(h) A client, responsible relative, and policyholder must provide income or wage
verification, household size verification, and must make an assignment of third-party payment
rights under paragraph (f). If a client, responsible relative, or policyholder does not comply
with the provisions of this subdivision, the client is ineligible for behavioral health fund
payment for substance use disorder treatment, and the client and responsible relative must
be obligated to pay for the full cost of substance use disorder treatment services provided
to the client.

Sec. 5.

Minnesota Statutes 2023 Supplement, section 254B.05, subdivision 5, is amended
to read:

Subd. 5.

Rate requirements.

(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.

(b) Eligible substance use disorder treatment services include:

(1) those licensed, as applicable, according to chapter 245G or applicable Tribal license
and provided according to the following ASAM levels of care:

(i) ASAM level 0.5 early intervention services provided according to section 254B.19,
subdivision 1, clause (1);

(ii) ASAM level 1.0 outpatient services provided according to section 254B.19,
subdivision 1, clause (2);

(iii) ASAM level 2.1 intensive outpatient services provided according to section 254B.19,
subdivision 1, clause (3);

(iv) ASAM level 2.5 partial hospitalization services provided according to section
254B.19, subdivision 1, clause (4);

(v) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5);

(vi) ASAM level 3.3 clinically managed population-specific high-intensity residential
services provided according to section 254B.19, subdivision 1, clause (6); and

(vii) ASAM level 3.5 clinically managed high-intensity residential services provided
according to section 254B.19, subdivision 1, clause (7);

(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;

(3) treatment coordination services provided according to section 245G.07, subdivision
1, paragraph (a), clause (5);

(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);

(5) withdrawal management services provided according to chapter 245F;

(6) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;

(7) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;

(8) ASAM 3.5 clinically managed high-intensity residential services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license, which
provide ASAM level of care 3.5 according to section 254B.19, subdivision 1, clause (7),
and are provided by a state-operated vendor or to clients who have been civilly committed
to the commissioner, present the most complex and difficult care needs, and are a potential
threat to the community; and

(9) room and board facilities that meet the requirements of subdivision 1a.

(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:

(1) programs that serve parents with their children if the program:

(i) provides on-site child care during the hours of treatment activity that:

(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or

(B) is licensed under chapter 245A and sections 245G.01 to 245G.19; or

(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:

(A) a child care center under Minnesota Rules, chapter 9503; or

(B) a family child care home under Minnesota Rules, chapter 9502;

(2) culturally specific or culturally responsive programs as defined in section 254B.01,
subdivision 4a;

(3) disability responsive programs as defined in section 254B.01, subdivision 4b;

(4) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to deleted text begin two hours deleted text end new text begin one hour new text end per client per week if the medical needs
of the client and the nature and provision of any medical services provided are documented
in the client file; or

(5) programs that offer services to individuals with co-occurring mental health and
substance use disorder problems if:

(i) the program meets the co-occurring requirements in section 245G.20;

(ii) deleted text begin 25 percent of the counseling staff are licensed mental health professionals under
section 245I.04, subdivision 2, or are students or licensing candidates under the supervision
of a licensed alcohol and drug counselor supervisor and mental health professional under
section 245I.04, subdivision 2, except that no more than 50 percent of the mental health
staff may be students or licensing candidates with time documented to be directly related
to provisions of co-occurring services deleted text end new text begin the program employs a mental health professional as
defined in section 245I.04, subdivision 2 new text end ;

(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;

(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;

(v) family education is offered that addresses mental health and substance use disorder
and the interaction between the two; and

(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.

(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the substance use disorder facility of the child care provider's current licensure to provide
child care services.

(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).

(f) Subject to federal approval, substance use disorder services that are otherwise covered
as direct face-to-face services may be provided via telehealth as defined in section 256B.0625,
subdivision 3b. The use of telehealth to deliver services must be medically appropriate to
the condition and needs of the person being served. Reimbursement shall be at the same
rates and under the same conditions that would otherwise apply to direct face-to-face services.

(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.

(h) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.

(i) Payment for substance use disorder services under this section must start from the
day of service initiation, when the comprehensive assessment is completed within the
required timelines.

new text begin (j) A license holder that is unable to provide all residential treatment services because
a client missed services remains eligible to bill for the client's intensity level of services
under this paragraph if the license holder can document the reason the client missed services
and the interventions done to address the client's absence.
new text end

new text begin (k) Hours in a treatment week may be reduced in observance of federally recognized
holidays.
new text end

Sec. 6.

Laws 2021, First Special Session chapter 7, article 11, section 38, as amended by
Laws 2022, chapter 98, article 4, section 50, is amended to read:

Sec. 38. DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT PAPERWORK REDUCTION.

(a) The commissioner of human services, in consultation with counties, tribes, managed
care organizations, substance use disorder treatment professional associations, and other
relevant stakeholders, shall develop, assess, and recommend systems improvements to
minimize regulatory paperwork and improve systems for substance use disorder programs
licensed under Minnesota Statutes, chapter 245A, and regulated under Minnesota Statutes,
chapters 245F and 245G, and Minnesota Rules, chapters 2960 and 9530. The commissioner
of human services shall make available any resources needed from other divisions within
the department to implement systems improvements.

(b) The commissioner of health shall make available needed information and resources
from the Division of Health Policy.

(c) The Office of MN.IT Services shall provide advance consultation and implementation
of the changes needed in data systems.

(d) The commissioner of human services shall contract with a vendor that has experience
with developing statewide system changes for multiple states at the payer and provider
levels. If the commissioner, after exercising reasonable diligence, is unable to secure a
vendor with the requisite qualifications, the commissioner may select the best qualified
vendor available. When developing recommendations, the commissioner shall consider
input from all stakeholders. The commissioner's recommendations shall maximize benefits
for clients and utility for providers, regulatory agencies, and payers.

(e) The commissioner of human services and the contracted vendor shall follow the
recommendations from the report issued in response to Laws 2019, First Special Session
chapter 9, article 6, section 76.

(f) deleted text begin Within two years of contracting with a qualified vendor according to paragraph (d) deleted text end new text begin
By December 15, 2024 new text end , the commissioner of human services shall take steps to implement
paperwork reductions and systems improvements within the commissioner's authority and
submit to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services a report that includes recommendations for
changes in statutes that would further enhance systems improvements to reduce paperwork.
The report shall include a summary of the approaches developed and assessed by the
commissioner of human services and stakeholders and the results of any assessments
conducted.