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SF 1160

5th Engrossment - 92nd Legislature (2021 - 2022) Posted on 04/07/2021 09:17am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 5th Engrossment

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A bill for an act
relating to health care; modifying coverage for health care services and consultation
provided through telehealth; establishing a task force on creating a person-centered
telepresence strategy; appropriating money; amending Minnesota Statutes 2020,
sections 147.033; 151.37, subdivision 2; 245G.01, subdivisions 13, 26; 245G.06,
subdivision 1; 254A.19, subdivision 5; 254B.05, subdivision 5; 256B.0596;
256B.0622, subdivision 7a; 256B.0625, subdivisions 3b, 13h, 20, 20b, 46, by
adding a subdivision; 256B.0924, subdivisions 4a, 6; 256B.094, subdivision 6;
256B.0943, subdivision 1; 256B.0947, subdivision 6; 256B.0949, subdivision 13;
proposing coding for new law in Minnesota Statutes, chapter 62A; repealing
Minnesota Statutes 2020, sections 62A.67; 62A.671; 62A.672.

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

Section 1.

new text begin [62A.673] COVERAGE OF SERVICES PROVIDED THROUGH
TELEHEALTH.
new text end

new text begin Subdivision 1. new text end

new text begin Citation. new text end

new text begin This section may be cited as the "Minnesota Telehealth Act."
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

new text begin (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.
new text end

new text begin (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 as
defined under section 245.462, subdivision 18, or 245.4871, subdivision 27; a mental health
practitioner as defined under section 245.462, subdivision 17, or 245.4871, subdivision 26;
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.
new text end

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

new text begin (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.
new text end

new text begin (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
transfer, the originating site also means the location at which a health care provider transfers
or transmits information to the distant site.
new text end

new text begin (g) "Store-and-forward transfer" means the asynchronous electronic transfer 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.
new text end

new text begin (h) "Telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual or audio-only 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 transfers, and synchronous
interactions between a patient located at an originating site and a health care provider located
at a distant site. Telehealth includes audio-only communication between a health care
provider and a patient 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. Telehealth
does not include communication between health care providers or between a health care
provider and a patient that consists solely of an e-mail or facsimile transmission. Telehealth
does not include communication between health care providers that consists solely of a
telephone conversation. Telehealth does not include telemonitoring services as defined in
paragraph (i).
new text end

new text begin (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.
new text end

new text begin Subd. 3. new text end

new text begin Coverage of telehealth. new text end

new text begin (a) A health plan sold, issued, or renewed by a health
carrier in Minnesota must (1) cover benefits delivered through telehealth in the same manner
as any other benefits covered under the health plan, and (2) comply with this section.
new text end

new text begin (b) Coverage for services delivered through telehealth must not be limited on the basis
of geography, location, or distance for travel subject to the health care provider network
available to the enrollee through the enrollee's health plan.
new text end

new text begin (c) A health carrier must not create a separate provider network to deliver services
through telehealth that does not include network providers who provide in-person care to
patients for the same service or require an enrollee to use a specific provider within the
network to receive services through telehealth.
new text end

new text begin (d) A health carrier may require a deductible, co-payment, or coinsurance payment for
a health care service provided through telehealth, provided that the deductible, co-payment,
or coinsurance payment is not in addition to, and does not exceed, the deductible, co-payment,
or coinsurance applicable for the same service provided through in-person contact.
new text end

new text begin (e) Nothing in this section:
new text end

new text begin (1) requires a health carrier to provide coverage for services that are not medically
necessary or are not covered under the enrollee's health plan; or
new text end

new text begin (2) prohibits a health carrier from:
new text end

new text begin (i) establishing criteria that a health care provider must meet to demonstrate the safety
or efficacy of delivering a particular service through telehealth for which the health carrier
does not already reimburse other health care providers for delivering the service through
telehealth; or
new text end

new text begin (ii) establishing reasonable medical management techniques, provided the criteria or
techniques are not unduly burdensome or unreasonable for the particular service; or
new text end

new text begin (iii) requiring documentation or billing practices designed to protect the health carrier
or patient from fraudulent claims, provided the practices are not unduly burdensome or
unreasonable for the particular service.
new text end

new text begin (f) Nothing in this section requires the use of telehealth when a health care provider
determines that the delivery of a health care service through telehealth is not appropriate or
when an enrollee chooses not to receive a health care service through telehealth.
new text end

new text begin Subd. 4. new text end

new text begin Parity between telehealth and in-person services. new text end

new text begin (a) A health carrier must
not restrict or deny coverage of a health care service that is covered under a health plan
solely:
new text end

new text begin (1) because the health care service provided by the health care provider through telehealth
is not provided through in-person contact; or
new text end

new text begin (2) based on the communication technology or application used to deliver the health
care service through telehealth, provided the technology or application complies with this
section and is appropriate for the particular service.
new text end

new text begin (b) Prior authorization may be required for health care services delivered through
telehealth only if prior authorization is required before the delivery of the same service
through in-person contact.
new text end

new text begin (c) A health carrier may require a utilization review for services delivered through
telehealth, provided the utilization review is conducted in the same manner and uses the
same clinical review criteria as a utilization review for the same services delivered through
in-person contact.
new text end

new text begin (d) A health carrier or health care provider shall not require an enrollee to pay a fee to
download a specific communication technology or application.
new text end

new text begin Subd. 5. new text end

new text begin Reimbursement for services delivered through telehealth. new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 6. new text end

new text begin Telehealth equipment. new text end

new text begin (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.
new text end

new text begin (b) A health carrier must provide coverage for health care services delivered through
telehealth by means of the use of audio-only telephone 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.
new text end

new text begin Subd. 7. new text end

new text begin Telemonitoring services. new text end

new text begin A health carrier must provide coverage for
telemonitoring services if:
new text end

new text begin (1) the telemonitoring service is medically appropriate based on the enrollee's medical
condition or status;
new text end

new text begin (2) the enrollee is cognitively and physically capable of operating the monitoring device
or equipment, or the enrollee has a caregiver who is willing and able to assist with the
monitoring device or equipment; and
new text end

new text begin (3) the enrollee resides in a setting that is suitable for telemonitoring and not in a setting
that has health care staff on site.
new text end

Sec. 2.

Minnesota Statutes 2020, section 147.033, is amended to read:


147.033 PRACTICE OF deleted text beginTELEMEDICINEdeleted text endnew text begin TELEHEALTHnew text end.

Subdivision 1.

Definition.

For the purposes of this section, deleted text begin"telemedicine" means the
delivery of health care services or consultations while the patient is at an originating site
and the licensed health care provider is at a distant site. A communication between licensed
health care providers that consists solely of a telephone conversation, e-mail, or facsimile
transmission does not constitute telemedicine consultations or services. A communication
between a licensed health care provider and a patient that consists solely of an e-mail or
facsimile transmission does not constitute telemedicine consultations or services.
Telemedicine may be provided by means of real-time two-way interactive audio, and visual
communications, including the application of secure video conferencing or store-and-forward
technology to provide or support health care delivery, that facilitate the assessment, diagnosis,
consultation, treatment, education, and care management of a patient's health care.
deleted text endnew text begin
"telehealth" has the meaning given in section 62A.673, subdivision 2, paragraph (h).
new text end

Subd. 2.

Physician-patient relationship.

A physician-patient relationship may be
established through deleted text begintelemedicinedeleted text endnew text begin telehealthnew text end.

Subd. 3.

Standards of practice and conduct.

A physician providing health care services
by deleted text begintelemedicinedeleted text endnew text begin telehealthnew text end in this state shall be held to the same standards of practice and
conduct as provided in this chapter for in-person health care services.

Sec. 3.

Minnesota Statutes 2020, section 151.37, subdivision 2, is amended to read:


Subd. 2.

Prescribing and filing.

(a) A licensed practitioner in the course of professional
practice only, may prescribe, administer, and dispense a legend drug, and may cause the
same to be administered by a nurse, a physician assistant, or medical student or resident
under the practitioner's direction and supervision, and may cause a person who is an
appropriately certified, registered, or licensed health care professional to prescribe, dispense,
and administer the same within the expressed legal scope of the person's practice as defined
in Minnesota Statutes. A licensed practitioner may prescribe a legend drug, without reference
to a specific patient, by directing a licensed dietitian or licensed nutritionist, pursuant to
section 148.634; a nurse, pursuant to section 148.235, subdivisions 8 and 9; physician
assistant; medical student or resident; or pharmacist according to section 151.01, subdivision
27, to adhere to a particular practice guideline or protocol when treating patients whose
condition falls within such guideline or protocol, and when such guideline or protocol
specifies the circumstances under which the legend drug is to be prescribed and administered.
An individual who verbally, electronically, or otherwise transmits a written, oral, or electronic
order, as an agent of a prescriber, shall not be deemed to have prescribed the legend drug.
This paragraph applies to a physician assistant only if the physician assistant meets the
requirements of deleted text beginsection 147A.18deleted text endnew text begin sections 147A.02 and 147A.09new text end.

(b) The commissioner of health, if a licensed practitioner, or a person designated by the
commissioner who is a licensed practitioner, may prescribe a legend drug to an individual
or by protocol for mass dispensing purposes where the commissioner finds that the conditions
triggering section 144.4197 or 144.4198, subdivision 2, paragraph (b), exist. The
commissioner, if a licensed practitioner, or a designated licensed practitioner, may prescribe,
dispense, or administer a legend drug or other substance listed in subdivision 10 to control
tuberculosis and other communicable diseases. The commissioner may modify state drug
labeling requirements, and medical screening criteria and documentation, where time is
critical and limited labeling and screening are most likely to ensure legend drugs reach the
maximum number of persons in a timely fashion so as to reduce morbidity and mortality.

(c) A licensed practitioner that dispenses for profit a legend drug that is to be administered
orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must file with the
practitioner's licensing board a statement indicating that the practitioner dispenses legend
drugs for profit, the general circumstances under which the practitioner dispenses for profit,
and the types of legend drugs generally dispensed. It is unlawful to dispense legend drugs
for profit after July 31, 1990, unless the statement has been filed with the appropriate
licensing board. For purposes of this paragraph, "profit" means (1) any amount received by
the practitioner in excess of the acquisition cost of a legend drug for legend drugs that are
purchased in prepackaged form, or (2) any amount received by the practitioner in excess
of the acquisition cost of a legend drug plus the cost of making the drug available if the
legend drug requires compounding, packaging, or other treatment. The statement filed under
this paragraph is public data under section 13.03. This paragraph does not apply to a licensed
doctor of veterinary medicine or a registered pharmacist. Any person other than a licensed
practitioner with the authority to prescribe, dispense, and administer a legend drug under
paragraph (a) shall not dispense for profit. To dispense for profit does not include dispensing
by a community health clinic when the profit from dispensing is used to meet operating
expenses.

(d) A prescription drug order for the following drugs is not valid, unless it can be
established that the prescription drug order was based on a documented patient evaluation,
including an examination, adequate to establish a diagnosis and identify underlying conditions
and contraindications to treatment:

(1) controlled substance drugs listed in section 152.02, subdivisions 3 to 5;

(2) drugs defined by the Board of Pharmacy as controlled substances under section
152.02, subdivisions 7, 8, and 12;

(3) muscle relaxants;

(4) centrally acting analgesics with opioid activity;

(5) drugs containing butalbital; or

(6) phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.

deleted text begin For purposes of prescribing drugs listed in clause (6), the requirement for a documented
patient evaluation, including an examination, may be met through the use of telemedicine,
as defined in section 147.033, subdivision 1.
deleted text end

(e) For the purposes of paragraph (d), the requirement for an examination shall be met
ifnew text begin:
new text end

new text begin (1)new text end an in-person examination has been completed in any of the following circumstances:

deleted text begin (1)deleted text endnew text begin (i)new text end the prescribing practitioner examines the patient at the time the prescription or
drug order is issued;

deleted text begin (2)deleted text endnew text begin (ii)new text end the prescribing practitioner has performed a prior examination of the patient;

deleted text begin (3)deleted text endnew text begin (iii)new text end another prescribing practitioner practicing within the same group or clinic as
the prescribing practitioner has examined the patient;

deleted text begin (4)deleted text endnew text begin (iv)new text end a consulting practitioner to whom the prescribing practitioner has referred the
patient has examined the patient; or

deleted text begin (5)deleted text endnew text begin (v)new text end the referring practitioner has performed an examination in the case of a consultant
practitioner issuing a prescription or drug order when providing services by means of
telemedicinedeleted text begin.deleted text endnew text begin; or
new text end

new text begin (2) the prescription order is for a drug listed in paragraph (d), clause (6), or for medication
assisted therapy for a substance use disorder, and the prescribing practitioner has completed
an examination of the patient via telehealth as defined in section 62A.673, subdivision 2,
paragraph (h).
new text end

(f) Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing a
drug through the use of a guideline or protocol pursuant to paragraph (a).

(g) Nothing in this chapter prohibits a licensed practitioner from issuing a prescription
or dispensing a legend drug in accordance with the Expedited Partner Therapy in the
Management of Sexually Transmitted Diseases guidance document issued by the United
States Centers for Disease Control.

(h) Nothing in paragraph (d) or (e) limits prescription, administration, or dispensing of
legend drugs through a public health clinic or other distribution mechanism approved by
the commissioner of health or a community health board in order to prevent, mitigate, or
treat a pandemic illness, infectious disease outbreak, or intentional or accidental release of
a biological, chemical, or radiological agent.

(i) No pharmacist employed by, under contract to, or working for a pharmacy located
within the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug based on a prescription that the pharmacist knows, or would reasonably be expected
to know, is not valid under paragraph (d).

(j) No pharmacist employed by, under contract to, or working for a pharmacy located
outside the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug to a resident of this state based on a prescription that the pharmacist knows, or would
reasonably be expected to know, is not valid under paragraph (d).

(k) Nothing in this chapter prohibits the commissioner of health, if a licensed practitioner,
or, if not a licensed practitioner, a designee of the commissioner who is a licensed
practitioner, from prescribing legend drugs for field-delivered therapy in the treatment of
a communicable disease according to the Centers For Disease Control and Prevention Partner
Services Guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4.

Minnesota Statutes 2020, section 245G.01, subdivision 13, is amended to read:


Subd. 13.

Face-to-face.

"Face-to-face" means two-way, real-time, interactive deleted text beginand visualdeleted text end
communication between a client and a treatment service provider and includes services
delivered in person or via deleted text begintelemedicinedeleted text endnew text begin telehealth with priority being given to interactive
audio and visual communication, if available
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2020, section 245G.01, subdivision 26, is amended to read:


Subd. 26.

deleted text beginTelemedicinedeleted text endnew text begin Telehealthnew text end.

deleted text begin"Telemedicine"deleted text endnew text begin "Telehealth"new text end means the delivery
of a substance use disorder treatment service while the client is at an originating site and
the deleted text beginlicenseddeleted text end health care provider is at a distant sitenew text begin via telehealth as defined in section
256B.0625, subdivision 3b, and
new text end as specified in section 254B.05, subdivision 5, paragraph
(f).

Sec. 6.

Minnesota Statutes 2020, section 245G.06, subdivision 1, is amended to read:


Subdivision 1.

General.

Each client must have a person-centered individual treatment
plan developed by an alcohol and drug counselor within ten days from the day of service
initiation for a residential program and within five calendar days on which a treatment
session has been provided from the day of service initiation for a client in a nonresidential
program. Opioid treatment programs must complete the individual treatment plan within
21 days from the day of service initiation. The individual treatment plan must be signed by
the client and the alcohol and drug counselor and document the client's involvement in the
development of the plan. The individual treatment plan is developed upon the qualified staff
member's dated signature. Treatment planning must include ongoing assessment of client
needs. An individual treatment plan must be updated based on new information gathered
about the client's condition, the client's level of participation, and on whether methods
identified have the intended effect. A change to the plan must be signed by the client and
the alcohol and drug counselor. If the client chooses to have family or others involved in
treatment services, the client's individual treatment plan must include how the family or
others will be involved in the client's treatment.new text begin If a client is receiving treatment services
or an assessment via telehealth, the alcohol and drug counselor may document the client's
verbal approval of the treatment plan or change to the treatment plan in lieu of the client's
signature.
new text end

Sec. 7.

Minnesota Statutes 2020, section 254A.19, subdivision 5, is amended to read:


Subd. 5.

Assessment via deleted text begintelemedicinedeleted text endnew text begin telehealthnew text end.

Notwithstanding Minnesota Rules,
part 9530.6615, subpart 3, item A, a chemical use assessment may be conducted via
deleted text begin telemedicinedeleted text endnew text begin telehealth as defined in section 256B.0625, subdivision 3bnew text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 8.

Minnesota Statutes 2020, 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) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;

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

(3) care 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) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;

(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;

(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;

(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;

(9) 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;

(10) 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;

(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week 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

(12) 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) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; 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 programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:

(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;

(ii) is governed with significant input from individuals of that specific background; and

(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;

(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours 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; and

(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:

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

(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, 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;

(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 abuse disorders
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 chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.

(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, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via deleted text begintwo-way interactive videodeleted text endnew text begin telehealth as
defined in section 256B.0625, subdivision 3b
new text end. The use of deleted text begintwo-way interactive videodeleted text endnew text begin telehealth
to deliver services
new text end 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. deleted text beginThe interactive video equipment and
connection must comply with Medicare standards in effect at the time the service is provided.
deleted text end

(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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 9.

Minnesota Statutes 2020, section 256B.0596, is amended to read:


256B.0596 MENTAL HEALTH CASE MANAGEMENT.

Counties shall contract with eligible providers willing to provide mental health case
management services under section 256B.0625, subdivision 20. In order to be eligible, in
addition to general provider requirements under this chapter, the provider must:

(1) be willing to provide the mental health case management services; and

(2) have a minimum of at least one contact with the client per weeknew text begin, either in person or
through telehealth, and at least one face-to-face in-person contact with the client every six
months
new text end. This section is not intended to limit the ability of a county to provide its own mental
health case management services.

Sec. 10.

Minnesota Statutes 2020, section 256B.0622, subdivision 7a, is amended to read:


Subd. 7a.

Assertive community treatment team staff requirements and roles.

(a)
The required treatment staff qualifications and roles for an ACT team are:

(1) the team leader:

(i) shall be a licensed mental health professional who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A. Individuals who are not licensed but who are eligible
for licensure and are otherwise qualified may also fulfill this role but must obtain full
licensure within 24 months of assuming the role of team leader;

(ii) must be an active member of the ACT team and provide some direct services to
clients;

(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the team, providing clinical
oversight of services in conjunction with the psychiatrist or psychiatric care provider, and
supervising team members to ensure delivery of best and ethical practices; and

(iv) must be available to provide overall clinical oversight to the ACT team after regular
business hours and on weekends and holidays. The team leader may delegate this duty to
another qualified member of the ACT team;

(2) the psychiatric care provider:

(i) must be a licensed psychiatrist certified by the American Board of Psychiatry and
Neurology or eligible for board certification or certified by the American Osteopathic Board
of Neurology and Psychiatry or eligible for board certification, or a psychiatric nurse who
is qualified under Minnesota Rules, part 9505.0371, subpart 5, item A. The psychiatric care
provider must have demonstrated clinical experience working with individuals with serious
and persistent mental illness;

(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide clinical
supervision to the team;

(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;

(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;

(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role;

(vi) may deleted text beginnotdeleted text end provide deleted text beginspecific roles and responsibilities by telemedicine unless approved
by the commissioner
deleted text endnew text begin services through telehealth as defined under section 256B.0625,
subdivision 3b, when necessary to ensure the continuation of psychiatric and medication
services availability for clients and to maintain statutory requirements for psychiatric care
provider staffing levels
new text end; and

(vii) shall provide psychiatric backup to the program after regular business hours and
on weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;

(3) the nursing staff:

(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;

(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and

(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;

(4) the co-occurring disorder specialist:

(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and

(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;

(5) the vocational specialist:

(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;

(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and

(iii) should not refer individuals to receive any type of vocational services or linkage by
providers outside of the ACT team;

(6) the mental health certified peer specialist:

(i) shall be a full-time equivalent mental health certified peer specialist as defined in
section 256B.0615. No more than two individuals can share this position. The mental health
certified peer specialist is a fully integrated team member who provides highly individualized
services in the community and promotes the self-determination and shared decision-making
abilities of clients. This requirement may be waived due to workforce shortages upon
approval of the commissioner;

(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and

(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;

(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and

(8) additional staff:

(i) shall be based on team size. Additional treatment team staff may include licensed
mental health professionals as defined in Minnesota Rules, part 9505.0371, subpart 5, item
A; mental health practitioners as defined in section 245.462, subdivision 17; a mental health
practitioner working as a clinical trainee according to Minnesota Rules, part 9505.0371,
subpart 5, item C; or mental health rehabilitation workers as defined in section 256B.0623,
subdivision 5
, paragraph (a), clause (4). These individuals shall have the knowledge, skills,
and abilities required by the population served to carry out rehabilitation and support
functions; and

(ii) shall be selected based on specific program needs or the population served.

(b) Each ACT team must clearly document schedules for all ACT team members.

(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.

(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.

(e) Each ACT team member must fulfill training requirements established by the
commissioner.

Sec. 11.

Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:


Subd. 3b.

deleted text beginTelemedicinedeleted text endnew text begin Telehealthnew text end services.

(a) Medical assistance covers medically
necessary services and consultations delivered by a deleted text beginlicenseddeleted text end health care provider deleted text beginvia
telemedicine
deleted text endnew text begin through telehealthnew text end in the same manner as if the service or consultation was
delivered deleted text beginin persondeleted text endnew text begin through in-person contactnew text end. deleted text beginCoverage is limited to three telemedicine
services per enrollee per calendar week, except as provided in paragraph (f). Telemedicine
deleted text end
Services new text beginor consultations delivered through telehealth new text endshall be paid at the full allowable
rate.

(b) The commissioner deleted text beginshalldeleted text endnew text begin maynew text end establish criteria that a health care provider must attest
to in order to demonstrate the safety or efficacy of delivering a particular service deleted text beginvia
telemedicine
deleted text endnew text begin through telehealthnew text end. The attestation may include that the health care provider:

(1) has identified the categories or types of services the health care provider will provide
deleted text begin via telemedicinedeleted text endnew text begin through telehealthnew text end;

(2) has written policies and procedures specific to deleted text begintelemedicinedeleted text end servicesnew text begin delivered through
telehealth
new text end that are regularly reviewed and updated;

(3) has policies and procedures that adequately address patient safety before, during,
and after the deleted text begintelemedicinedeleted text end service is deleted text beginrendereddeleted text endnew text begin delivered through telehealthnew text end;

(4) has established protocols addressing how and when to discontinue telemedicine
services; and

(5) has an established quality assurance process related to deleted text begintelemedicinedeleted text endnew text begin deliveringnew text end servicesnew text begin
through telehealth
new text end.

(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service deleted text beginprovided by telemedicinedeleted text endnew text begin delivered through telehealthnew text end to a
medical assistance enrollee. Health care service records for services deleted text beginprovided by telemedicinedeleted text endnew text begin
delivered through telehealth
new text end must meet the requirements set forth in Minnesota Rules, part
9505.2175, subparts 1 and 2, and must document:

(1) the type of service deleted text beginprovided by telemedicinedeleted text endnew text begin delivered through telehealthnew text end;

(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(3) the deleted text beginlicenseddeleted text end health care provider's basis for determining that deleted text begintelemedicinedeleted text endnew text begin telehealthnew text end
is an appropriate and effective means for delivering the service to the enrollee;

(4) the mode of transmission deleted text beginofdeleted text endnew text begin used to delivernew text end the deleted text begintelemedicinedeleted text end service new text beginthrough telehealth
new text end and records evidencing that a particular mode of transmission was utilized;

(5) the location of the originating site and the distant site;

(6) if the claim for payment is based on a physician's deleted text begintelemedicinedeleted text end consultation with
another physiciannew text begin through telehealthnew text end, the written opinion from the consulting physician
providing the deleted text begintelemedicinedeleted text endnew text begin telehealthnew text end consultation; and

(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).

new text begin (d) Telehealth visits, as described in this subdivision provided through audio and visual
communication, may be used to satisfy the face-to-face requirement for reimbursement
under the payment methods that apply to a federally qualified health center, rural health
clinic, Indian health service, 638 tribal clinic, and certified community behavioral health
clinic, if the service would have otherwise qualified for payment if performed in person.
new text end

new text begin (e) For mental health services or assessments delivered through telehealth that are based
on an individual treatment plan, the provider may document the client's verbal approval of
the treatment plan or change in the treatment plan in lieu of the client's signature in
accordance with Minnesota Rules, part 9505.0371.
new text end

deleted text begin (d)deleted text endnew text begin (f)new text end For purposes of this subdivision, unless otherwise covered under this chapterdeleted text begin,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.
deleted text endnew text begin:
new text end

new text begin (1) "telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual or audio-only 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 transfers, and synchronous
interactions between a patient located at an originating site and a health care provider located
at a distant site.Telehealth does not include communication between health care providers
or between a health care provider and a patient that consists solely of a telephone
conversation, an e-mail, or facsimile transmission;
new text end

deleted text begin (e) For purposes of this section, "licenseddeleted text end new text begin(2) "new text endhealth care provider" means a deleted text beginlicenseddeleted text end
health care provider deleted text beginunder section 62A.671, subdivision 6deleted text endnew text begin as defined under section 62A.673new text end,
a community paramedic as defined under section 144E.001, subdivision 5f, deleted text beginor a mental
health practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision
26
, working under the general supervision of a mental health professional, and
deleted text end a community
health worker who meets the criteria under subdivision 49, paragraph (a)deleted text begin; "health care
provider" is defined under section 62A.671, subdivision 3;
deleted text endnew text begin, a mental health certified peer
specialist under section 256B.0615, subdivision 5, a mental health certified family peer
specialist under section 256B.0616, subdivision 5, a mental health rehabilitation worker
under section 256B.0623, subdivision 5, paragraph (a), clause (4), and paragraph (b), a
mental health behavioral aide under section 256B.0943, subdivision 7, paragraph (b), clause
(3), a treatment coordinator under section 245G.11, subdivision 7, an alcohol and drug
counselor under section 245G.11, subdivision 5, a recovery peer under section 245G.11,
subdivision 8, and a mental health case manager under section 245.462, subdivision 4, or
section 245.4871, subdivision 4;
new text end and

new text begin (3) new text end"originating site" deleted text beginis defined under section 62A.671, subdivision 7deleted text endnew text begin, "distant site," and
"store-and-forward transfer" have the meanings given in section 62A.673, subdivision 2
new text end.

deleted text begin (f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
deleted text end

deleted text begin (1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
deleted text end

deleted text begin (2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 12.

Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 3h. new text end

new text begin Telemonitoring services. new text end

new text begin (a) Medical assistance covers telemonitoring services
if:
new text end

new text begin (1) the telemonitoring service is medically appropriate based on the recipient's medical
condition or status;
new text end

new text begin (2) the recipient's health care provider has identified that telemonitoring services would
likely prevent the recipient's admission or readmission to a hospital, emergency room, or
nursing facility;
new text end

new text begin (3) the recipient is cognitively and physically capable of operating the monitoring device
or equipment, or the recipient has a caregiver who is willing and able to assist with the
monitoring device or equipment; and
new text end

new text begin (4) the recipient resides in a setting that is suitable for telemonitoring and not in a setting
that has health care staff on site.
new text end

new text begin (b) For purposes of this subdivision, "telemonitoring services" means the remote
monitoring of data related to a recipient's vital signs or biometric data by a monitoring
device or equipment that transmits the data electronically to a provider for analysis. The
assessment and monitoring of the health data transmitted by telemonitoring must be
performed by one of the following licensed health care professionals: physician, podiatrist,
registered nurse, advanced practice registered nurse, physician assistant, respiratory therapist,
or licensed professional working under the supervision of a medical director.
new text end

Sec. 13.

Minnesota Statutes 2020, section 256B.0625, subdivision 13h, is amended to
read:


Subd. 13h.

Medication therapy management services.

(a) Medical assistance covers
medication therapy management services for a recipient taking prescriptions to treat or
prevent one or more chronic medical conditions. For purposes of this subdivision,
"medication therapy management" means the provision of the following pharmaceutical
care services by a licensed pharmacist to optimize the therapeutic outcomes of the patient's
medications:

(1) performing or obtaining necessary assessments of the patient's health status;

(2) formulating a medication treatment plan, which may include prescribing medications
or products in accordance with section 151.37, subdivision 14, 15, or 16;

(3) monitoring and evaluating the patient's response to therapy, including safety and
effectiveness;

(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;

(5) documenting the care delivered and communicating essential information to the
patient's other primary care providers;

(6) providing verbal education and training designed to enhance patient understanding
and appropriate use of the patient's medications;

(7) providing information, support services, and resources designed to enhance patient
adherence with the patient's therapeutic regimens; and

(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.

Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.

(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:

(1) have a valid license issued by the Board of Pharmacy of the state in which the
medication therapy management service is being performed;

(2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;new text begin and
new text end

deleted text begin (3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the setting,
or in home settings, including long-term care settings, group homes, and facilities providing
assisted living services, but excluding skilled nursing facilities; and
deleted text end

deleted text begin (4)deleted text endnew text begin (3)new text end make use of an electronic patient record system that meets state standards.

(c) For purposes of reimbursement for medication therapy management services, the
commissioner may enroll individual pharmacists as medical assistance providers. The
commissioner may also establish deleted text begincontact requirements between the pharmacist and recipient,
including limiting
deleted text end new text beginlimits on new text endthe number of reimbursable consultations per recipient.

(d) deleted text beginIf there are no pharmacists who meet the requirements of paragraph (b) practicing
within a reasonable geographic distance of the patient, a pharmacist who meets the
requirements may provide The
deleted text endnew text begin Medication therapy managementnew text end services new text beginmay be provided
new text end via deleted text begintwo-way interactive videodeleted text endnew text begin telehealth as defined in subdivision 3b and may be delivered
into a patient's residence
new text end. Reimbursement shall be at the same rates and under the same
conditions that would otherwise apply to the services provided. To qualify for reimbursement
under this paragraph, the pharmacist providing the services must meet the requirements of
paragraph (b)deleted text begin, and must be located within an ambulatory care setting that meets the
requirements of paragraph (b), clause (3). The patient must also be located within an
ambulatory care setting that meets the requirements of paragraph (b), clause (3). Services
provided under this paragraph may not be transmitted into the patient's residence
deleted text end.

deleted text begin (e) Medication therapy management services may be delivered into a patient's residence
via secure interactive video if the medication therapy management services are performed
electronically during a covered home care visit by an enrolled provider. Reimbursement
shall be at the same rates and under the same conditions that would otherwise apply to the
services provided. To qualify for reimbursement under this paragraph, the pharmacist
providing the services must meet the requirements of paragraph (b) and must be located
within an ambulatory care setting that meets the requirements of paragraph (b), clause (3).
deleted text end

Sec. 14.

Minnesota Statutes 2020, section 256B.0625, subdivision 20, is amended to read:


Subd. 20.

Mental health case management.

(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.

(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.

(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face new text beginin-person new text endcontact new text beginor contact by telehealth
that meets the requirements of subdivision 20b
new text end with the child, the child's parents, or the
child's legal representative. To receive payment for an eligible adult, the provider must
document:

(1) at least a face-to-face contact with the adult or the adult's legal representative or deleted text beginadeleted text end
contact by deleted text begininteractive videodeleted text endnew text begin telehealthnew text end that meets the requirements of subdivision 20b; or

(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact or a contact by deleted text begininteractive videodeleted text end new text begintelehealthnew text end that meets the
requirements of subdivision 20b with the adult or the adult's legal representative within the
preceding two months.

(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.

(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.

(f) Payment for mental health case management provided by vendors who contract with
a county or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribe. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribe may negotiate a team rate with a vendor who is a member of the team. The team
shall determine how to distribute the rate among its members. No reimbursement received
by contracted vendors shall be returned to the county or tribe, except to reimburse the county
or tribe for advance funding provided by the county or tribe to the vendor.

(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.

(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.

(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.

(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.

(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:

(1) the costs of developing and implementing this section; and

(2) programming the information systems.

(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.

(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.

(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:

(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or

(2) the limits and conditions which apply to federal Medicaid funding for this service.

(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.

(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.

Sec. 15.

Minnesota Statutes 2020, section 256B.0625, subdivision 20b, is amended to
read:


Subd. 20b.

Mental health targeted case management through deleted text begininteractive videodeleted text endnew text begin
telehealth
new text end.

(a) Subject to federal approval, contact made for targeted case management by
deleted text begin interactive videodeleted text endnew text begin telehealthnew text end shall be eligible for payment if:

(1) the person receiving targeted case management services is residing in:

(i) a hospital;

(ii) a nursing facility; or

(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
establishment or lodging establishment that provides supportive services or health supervision
services according to section 157.17 that is staffed 24 hours a day, seven days a week;

(2) deleted text begininteractive videodeleted text endnew text begin telehealthnew text end is in the best interests of the person and is deemed
appropriate by the person receiving targeted case management or the person's legal guardian,
the case management provider, and the provider operating the setting where the person is
residing;

(3) the use of deleted text begininteractive videodeleted text endnew text begin telehealthnew text end is approved as part of the person's written
personal service or case plan, taking into consideration the person's vulnerability and active
personal relationships; and

(4) deleted text begininteractive videodeleted text endnew text begin telehealthnew text end is used for up to, but not more than, 50 percent of the
minimum required face-to-face contact.

(b) The person receiving targeted case management or the person's legal guardian has
the right to choose and consent to the use of deleted text begininteractive videodeleted text endnew text begin telehealthnew text end under this subdivision
and has the right to refuse the use of deleted text begininteractive videodeleted text endnew text begin telehealthnew text end at any time.

(c) The commissioner shall establish criteria that a targeted case management provider
must attest to in order to demonstrate the safety or efficacy of delivering the service via
deleted text begin interactive videodeleted text endnew text begin telehealthnew text end. The attestation may include that the case management provider
has:

(1) written policies and procedures specific to deleted text begininteractive videodeleted text end services new text begindelivered by
telehealth
new text endthat are regularly reviewed and updated;

(2) policies and procedures that adequately address client safety before, during, and after
the deleted text begininteractive videodeleted text end services are renderednew text begin by telehealthnew text end;

(3) established protocols addressing how and when to discontinue deleted text begininteractive videodeleted text end
servicesnew text begin delivered by telehealthnew text end; and

(4) established a quality assurance process related to deleted text begininteractive videodeleted text end servicesnew text begin delivered
by telehealth
new text end.

(d) As a condition of payment, the targeted case management provider must document
the following for each occurrence of targeted case management provided by deleted text begininteractive
video
deleted text endnew text begin telehealthnew text end:

(1) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(2) the basis for determining that deleted text begininteractive videodeleted text endnew text begin telehealthnew text end is an appropriate and
effective means for delivering the service to the person receiving case management services;

(3) the mode of transmission of the deleted text begininteractive videodeleted text end services new text begindelivered by telehealth
new text end and records evidencing that a particular mode of transmission was utilized;

(4) the location of the originating site and the distant site; and

(5) compliance with the criteria attested to by the targeted case management provider
as provided in paragraph (c).

new text begin (e) For purposes of this section, telehealth is defined in accordance with section
256B.0625, subdivision 3b.
new text end

Sec. 16.

Minnesota Statutes 2020, section 256B.0625, subdivision 46, is amended to read:


Subd. 46.

Mental health deleted text begintelemedicinedeleted text endnew text begin telehealthnew text end.

deleted text beginEffective January 1, 2006, anddeleted text end Subject
to federal approval, mental health services that are otherwise covered by medical assistance
as direct face-to-face services may be provided via deleted text begintwo-way interactive videodeleted text endnew text begin telehealth as
defined in subdivision 3b
new text end. Use of deleted text begintwo-way interactive videodeleted text endnew text begin telehealth to deliver servicesnew text end
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. deleted text beginThe interactive video equipment and connection must comply with
Medicare standards in effect at the time the service is provided.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 17.

Minnesota Statutes 2020, section 256B.0924, subdivision 4a, is amended to read:


Subd. 4a.

Targeted case management through deleted text begininteractive videodeleted text end new text begintelehealthnew text end.

(a) Subject
to federal approval, contact made for targeted case management by deleted text begininteractive videodeleted text end
new text begin telehealth as defined under section 256B.0625, subdivision 3b,new text end shall be eligible for payment
under subdivision 6 if:

(1) the person receiving targeted case management services is residing in:

(i) a hospital;

(ii) a nursing facility; or

(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
establishment or lodging establishment that provides supportive services or health supervision
services according to section 157.17 that is staffed 24 hours a day, seven days a week;

(2) deleted text begininteractive videodeleted text endnew text begin telehealthnew text end is in the best interests of the person and is deemed
appropriate by the person receiving targeted case management or the person's legal guardian,
the case management provider, and the provider operating the setting where the person is
residing;

(3) the use of deleted text begininteractive videodeleted text endnew text begin telehealthnew text end is approved as part of the person's written
personal service or case plan; and

(4) deleted text begininteractive videodeleted text endnew text begin telehealthnew text end is used for up to, but not more than, 50 percent of the
minimum required face-to-face contact.

(b) The person receiving targeted case management or the person's legal guardian has
the right to choose and consent to the use of deleted text begininteractive videodeleted text endnew text begin telehealthnew text end under this subdivision
and has the right to refuse the use of deleted text begininteractive videodeleted text endnew text begin telehealthnew text end at any time.

(c) The commissioner shall establish criteria that a targeted case management provider
must attest to in order to demonstrate the safety or efficacy of delivering the service via
deleted text begin interactive videodeleted text endnew text begin telehealthnew text end. The attestation may include that the case management provider
has:

(1) written policies and procedures specific to deleted text begininteractive videodeleted text end services new text begindelivered by
telehealth
new text endthat are regularly reviewed and updated;

(2) policies and procedures that adequately address client safety before, during, and after
the deleted text begininteractive videodeleted text end services are renderednew text begin by telehealthnew text end;

(3) established protocols addressing how and when to discontinue deleted text begininteractive videodeleted text end
servicesnew text begin delivered by telehealthnew text end; and

(4) established a quality assurance process related to deleted text begininteractive videodeleted text end servicesnew text begin delivered
by telehealth
new text end.

(d) As a condition of payment, the targeted case management provider must document
the following for each occurrence of targeted case management provided by deleted text begininteractive
video
deleted text endnew text begin telehealthnew text end:

(1) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(2) the basis for determining that deleted text begininteractive videodeleted text end new text begintelehealth new text endis an appropriate and
effective means for delivering the service to the person receiving case management services;

(3) the mode of transmission of the deleted text begininteractive videodeleted text end services new text begindelivered by telehealth
new text end and records evidencing that a particular mode of transmission was utilized;

(4) the location of the originating site and the distant site; and

(5) compliance with the criteria attested to by the targeted case management provider
as provided in paragraph (c).

new text begin (e) For purposes of this section, telehealth is defined in accordance with section
256B.0625, subdivision 3b.
new text end

Sec. 18.

Minnesota Statutes 2020, section 256B.0924, subdivision 6, is amended to read:


Subd. 6.

Payment for targeted case management.

(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis.
In order to receive payment for an eligible adult, the provider must document at least one
contact per monthnew text begin, either in person or by telehealth,new text end and not more than two consecutive
months without a face-to-face new text beginin-person new text endcontact with the adult or the adult's legal
representative, family, primary caregiver, or other relevant persons identified as necessary
to the development or implementation of the goals of the personal service plan.

(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), calculated as one combined average rate together with adult mental health
case management under section 256B.0625, subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section shall be the same as
the rate for adult mental health case management in effect as of December 31, 2001. Billing
and payment must identify the recipient's primary population group to allow tracking of
revenues.

(c) Payment for targeted case management provided by county-contracted vendors shall
be based on a monthly rate negotiated by the host county. The negotiated rate must not
exceed the rate charged by the vendor for the same service to other payers. If the service is
provided by a team of contracted vendors, the county may negotiate a team rate with a
vendor who is a member of the team. The team shall determine how to distribute the rate
among its members. No reimbursement received by contracted vendors shall be returned
to the county, except to reimburse the county for advance funding provided by the county
to the vendor.

(d) If the service is provided by a team that includes contracted vendors and county staff,
the costs for county staff participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor and the county may each
receive separate payment for services provided by each entity in the same month. In order
to prevent duplication of services, the county must document, in the recipient's file, the need
for team targeted case management and a description of the different roles of the team
members.

(e) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as
defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds.

(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is responsible for any federal
disallowances. The county may share this responsibility with its contracted vendors.

(g) The commissioner shall set aside five percent of the federal funds received under
this section for use in reimbursing the state for costs of developing and implementing this
section.

(h) Payments to counties for targeted case management expenditures under this section
shall only be made from federal earnings from services provided under this section. Payments
to contracted vendors shall include both the federal earnings and the county share.

(i) Notwithstanding section 256B.041, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of management
and budget. For the purposes of targeted case management services provided by county
staff under this section, the centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services provided under this section.

(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the lesser of:

(1) the last 180 days of the recipient's residency in that facility; or

(2) the limits and conditions which apply to federal Medicaid funding for this service.

(k) Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.

(l) Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.

Sec. 19.

Minnesota Statutes 2020, section 256B.094, subdivision 6, is amended to read:


Subd. 6.

Medical assistance reimbursement of case management services.

(a) Medical
assistance reimbursement for services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between the case manager and the
client, client's family, primary caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of the goals of the individual
service plan regarding the status of the client, the individual service plan, or the goals for
the client. These contacts must meet the minimum standards in clauses (1) and (2):

(1) there must be a face-to-face contact at least once a month except as provided in clause
(2); and

(2) for a client placed outside of the county of financial responsibility, or a client served
by tribal social services placed outside the reservation, in an excluded time facility under
section 256G.02, subdivision 6, or through the Interstate Compact for the Placement of
Children, section 260.93, and the placement in either case is more than 60 miles beyond
the county or reservation boundaries, there must be at least one contact per month and not
more than two consecutive months without a face-to-face contact.

new text begin Face-to-face contact under this paragraph may be conducted through telehealth for up to
two consecutive contacts following each in-person contact.
new text end

(b) Except as provided under paragraph (c), the payment rate is established using time
study data on activities of provider service staff and reports required under sections 245.482
and 256.01, subdivision 2, paragraph (p).

(c) Payments for tribes may be made according to section 256B.0625 or other relevant
federally approved rate setting methodology for child welfare targeted case management
provided by Indian health services and facilities operated by a tribe or tribal organization.

(d) Payment for case management provided by county or tribal social services contracted
vendors shall be based on a monthly rate negotiated by the host county or tribal social
services. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribal social services may negotiate a team rate with a vendor who is a member of the
team. The team shall determine how to distribute the rate among its members. No
reimbursement received by contracted vendors shall be returned to the county or tribal social
services, except to reimburse the county or tribal social services for advance funding provided
by the county or tribal social services to the vendor.

(e) If the service is provided by a team that includes contracted vendors and county or
tribal social services staff, the costs for county or tribal social services staff participation in
the team shall be included in the rate for county or tribal social services provided services.
In this case, the contracted vendor and the county or tribal social services may each receive
separate payment for services provided by each entity in the same month. To prevent
duplication of services, each entity must document, in the recipient's file, the need for team
case management and a description of the roles and services of the team members.

Separate payment rates may be established for different groups of providers to maximize
reimbursement as determined by the commissioner. The payment rate will be reviewed
annually and revised periodically to be consistent with the most recent time study and other
data. Payment for services will be made upon submission of a valid claim and verification
of proper documentation described in subdivision 7. Federal administrative revenue earned
through the time study, or under paragraph (c), shall be distributed according to earnings,
to counties, reservations, or groups of counties or reservations which have the same payment
rate under this subdivision, and to the group of counties or reservations which are not
certified providers under section 256F.10. The commissioner shall modify the requirements
set out in Minnesota Rules, parts 9550.0300 to 9550.0370, as necessary to accomplish this.

Sec. 20.

Minnesota Statutes 2020, 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 to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15
, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. 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) "Clinical trainee" means a mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item C.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a. Crisis
assistance entails the development of a written plan to assist a child's family to contend with
a potential crisis and is distinct from the immediate provision of crisis intervention services.

(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 mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a multidisciplinary team, under the clinical supervision of a
mental health professional.

(g) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 9505.0372,
subpart 1.

(h) "Direct service time" means the time that a mental health professional, clinical trainee,
mental health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family or providing covered deleted text begintelemedicinedeleted text end servicesnew text begin through tehehealth as
defined under section 256B.0625, subdivision 3b
new text end. Direct service time includes time in which
the provider obtains a client's history, develops a client's treatment plan, records individual
treatment outcomes, 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 or maintaining clinical records.

(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.

(k) "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. The individual behavioral plan may be incorporated into the child's individual
treatment plan so long as the behavioral plan is separately communicable to the mental
health behavioral aide.

(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part 9505.0371,
subpart 7.

(m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3), to assist a child retain or generalize psychosocial skills as previously
trained by a mental health professional or mental health practitioner and as described in the
child's individual treatment plan and individual behavior plan. Activities involve working
directly with the child or child's family as provided in subdivision 9, paragraph (b), clause
(4).

(n) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17
, except that a practitioner working in a day treatment setting may qualify as a mental
health practitioner if the practitioner holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or university, and: (1) has at least 2,000
hours of clinically supervised experience in the delivery of mental health services to clients
with mental illness; (2) is fluent in the language, other than English, of the cultural group
that makes up at least 50 percent of the practitioner's clients, completes 40 hours of training
on the delivery of services to clients with mental illness, and receives clinical supervision
from a mental health professional at least once per week until meeting the required 2,000
hours of supervised experience; or (3) receives 40 hours of training on the delivery of
services to clients with mental illness within six months of employment, and clinical
supervision from a mental health professional at least once per week until meeting the
required 2,000 hours of supervised experience.

(o) "Mental health professional" means an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18.

(p) "Mental health service plan development" includes:

(1) the development, review, and revision of a child's individual treatment plan, as
provided in Minnesota Rules, part 9505.0371, subpart 7, including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and

(2) administering standardized outcome measurement instruments, determined and
updated by the commissioner, as periodically needed to evaluate the effectiveness of
treatment for children receiving clinical services and reporting outcome measures, as required
by the commissioner.

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

(r) "Psychotherapy" means the treatment of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plan.

(s) "Rehabilitative services" or "psychiatric rehabilitation services" means a series or
multidisciplinary combination of psychiatric and psychosocial interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
psychotherapy to address internal psychological, emotional, and intellectual processing
deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.

(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).

Sec. 21.

Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:


Subd. 6.

Service standards.

The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.

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

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

(c) Services must be age-appropriate and meet the specific needs of the client.

(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.

(e) An individual treatment plan must:

(1) be based on the information in the client's diagnostic assessment and baselines;

(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;

(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;

(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;

(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;

(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;

(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;

(8) if a need for substance use disorder treatment is indicated by validated assessment:

(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;

(ii) be reviewed at least once every 90 days and revised, if necessary;

(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and

(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.

(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.

(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.

(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.

new text begin (i) The services and responsibilities of the psychiatric provider may be provided through
telehealth as defined under section 256B.0625, subdivision 3b, when necessary to prevent
disruption in client services or to maintain the required psychiatric staffing level.
new text end

Sec. 22.

Minnesota Statutes 2020, section 256B.0949, subdivision 13, is amended to read:


Subd. 13.

Covered services.

(a) The services described in paragraphs (b) to (l) are
eligible for reimbursement by medical assistance under this section. Services must be
provided by a qualified EIDBI provider and supervised by a QSP. An EIDBI service must
address the person's medically necessary treatment goals and must be targeted to develop,
enhance, or maintain the individual developmental skills of a person with ASD or a related
condition to improve functional communication, including nonverbal or social
communication, social or interpersonal interaction, restrictive or repetitive behaviors,
hyperreactivity or hyporeactivity to sensory input, behavioral challenges and self-regulation,
cognition, learning and play, self-care, and safety.

(b) EIDBI treatment must be delivered consistent with the standards of an approved
modality, as published by the commissioner. EIDBI modalities include:

(1) applied behavior analysis (ABA);

(2) developmental individual-difference relationship-based model (DIR/Floortime);

(3) early start Denver model (ESDM);

(4) PLAY project;

(5) relationship development intervention (RDI); or

(6) additional modalities not listed in clauses (1) to (5) upon approval by the
commissioner.

(c) An EIDBI provider may use one or more of the EIDBI modalities in paragraph (b),
clauses (1) to (5), as the primary modality for treatment as a covered service, or several
EIDBI modalities in combination as the primary modality of treatment, as approved by the
commissioner. An EIDBI provider that identifies and provides assurance of qualifications
for a single specific treatment modality must document the required qualifications to meet
fidelity to the specific model.

(d) Each qualified EIDBI provider must identify and provide assurance of qualifications
for professional licensure certification, or training in evidence-based treatment methods,
and must document the required qualifications outlined in subdivision 15 in a manner
determined by the commissioner.

(e) CMDE is a comprehensive evaluation of the person's developmental status to
determine medical necessity for EIDBI services and meets the requirements of subdivision
5. The services must be provided by a qualified CMDE provider.

(f) EIDBI intervention observation and direction is the clinical direction and oversight
of EIDBI services by the QSP, level I treatment provider, or level II treatment provider,
including developmental and behavioral techniques, progress measurement, data collection,
function of behaviors, and generalization of acquired skills for the direct benefit of a person.
EIDBI intervention observation and direction informs any modification of the current
treatment protocol to support the outcomes outlined in the ITP.

(g) Intervention is medically necessary direct treatment provided to a person with ASD
or a related condition as outlined in their ITP. All intervention services must be provided
under the direction of a QSP. Intervention may take place across multiple settings. The
frequency and intensity of intervention services are provided based on the number of
treatment goals, person and family or caregiver preferences, and other factors. Intervention
services may be provided individually or in a group. Intervention with a higher provider
ratio may occur when deemed medically necessary through the person's ITP.

(1) Individual intervention is treatment by protocol administered by a single qualified
EIDBI provider delivered deleted text beginface-to-facedeleted text end to one person.

(2) Group intervention is treatment by protocol provided by one or more qualified EIDBI
providers, delivered to at least two people who receive EIDBI services.

(h) ITP development and ITP progress monitoring is development of the initial, annual,
and progress monitoring of an ITP. ITP development and ITP progress monitoring documents
provide oversight and ongoing evaluation of a person's treatment and progress on targeted
goals and objectives and integrate and coordinate the person's and the person's legal
representative's information from the CMDE and ITP progress monitoring. This service
must be reviewed and completed by the QSP, and may include input from a level I provider
or a level II provider.

(i) Family caregiver training and counseling is specialized training and education for a
family or primary caregiver to understand the person's developmental status and help with
the person's needs and development. This service must be provided by the QSP, level I
provider, or level II provider.

(j) A coordinated care conference is a voluntary deleted text beginface-to-facedeleted text end meeting with the person
and the person's family to review the CMDE or ITP progress monitoring and to integrate
and coordinate services across providers and service-delivery systems to develop the ITP.
This service must be provided by the QSP and may include the CMDE provider or a level
I provider or a level II provider.

(k) Travel time is allowable billing for traveling to and from the person's home, school,
a community setting, or place of service outside of an EIDBI center, clinic, or office from
a specified location to provide deleted text beginface-to-facedeleted text endnew text begin in-personnew text end EIDBI intervention, observation and
direction, or family caregiver training and counseling. The person's ITP must specify the
reasons the provider must travel to the person.

(l) Medical assistance covers medically necessary EIDBI services and consultations
delivered by a licensed health care provider via deleted text begintelemedicinedeleted text endnew text begin telehealthnew text end, as defined under
section 256B.0625, subdivision 3b, in the same manner as if the service or consultation was
delivered in person.

Sec. 23. new text beginCOMMISSIONER OF HUMAN SERVICES; EXTENSION OF COVID-19
HUMAN SERVICES PROGRAM MODIFICATIONS.
new text end

new text begin Notwithstanding Laws 2020, First Special Session chapter 7, section 1, subdivision 2,
as amended by Laws 2020, First Special Session chapter 1, section 3, when the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, the following modifications issued by
the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and
including any amendments to the modification issued before the peacetime emergency
expires, shall remain in effect until June 30, 2023:
new text end

new text begin (1) CV16: expanding access to telemedicine services for Children's Health Insurance
Program, Medical Assistance, and MinnesotaCare enrollees;
new text end

new text begin (2) CV21: allowing telemedicine alternative for school-linked mental health services
and intermediate school district mental health services;
new text end

new text begin (3) CV24: allowing phone or video use for targeted case management visits;
new text end

new text begin (4) CV30: expanding telemedicine in health care, mental health, and substance use
disorder settings; and
new text end

new text begin (5) CV45: permitting comprehensive assessments to be completed by telephone or video
communication and permitting a counselor, recovery peer, or treatment coordinator to
provide treatment services from their home by telephone or video communication to a client
in their home.
new text end

Sec. 24. new text beginEXPANDING TELEHEALTH DELIVERY OPTIONS STUDY.
new text end

new text begin The commissioner of human services, in consultation with providers, shall study the
viability of the use of audio-only communication as a permitted option for delivering services
through telehealth within the public health care programs. The study shall examine the use
of audio-only communication in supporting equitable access to health care services, including
behavioral health services for the elderly, rural communities, and communities of color,
and eliminating barriers for vulnerable and underserved populations. The commissioner
shall submit recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finances, by
December 15, 2022.
new text end

Sec. 25. new text beginSTUDY OF TELEHEALTH.
new text end

new text begin (a) The commissioner of health, in consultation with the commissioner of human services,
shall study the impact of telehealth payment methodologies and expansion under this act
on the coverage and provision of telehealth services under public health care programs and
private health insurance. The study shall review:
new text end

new text begin (1) the impacts of telehealth payment methodologies and expansion on access to health
care services, quality of care, and value-based payments and innovation in care delivery;
new text end

new text begin (2) the short-term and long-term impacts of telehealth payment methodologies and
expansion in reducing health care disparities and providing equitable access for underserved
communities; and
new text end

new text begin (3) and make recommendations on interstate licensing options for health care
professionals by reviewing advances in the delivery of health care through interstate telehealth
while ensuring the safety and health of patients.
new text end

new text begin (b) In conducting the study, the commissioner shall consult with stakeholders and
communities impacted by telehealth payment and expansion. The commissioner,
notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, may use data available
under that section to conduct the study. The commissioner shall report findings to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
and human services policy and finance and commerce, by February 15, 2024.
new text end

Sec. 26. new text beginTASK FORCE ON A PUBLIC-PRIVATE TELEPRESENCE STRATEGY.
new text end

new text begin Subdivision 1. new text end

new text begin Membership. new text end

new text begin (a) The task force on person-centered telepresence platform
strategy consists of the following 20 members:
new text end

new text begin (1) two senators, one appointed by the majority leader of the senate and one appointed
by the minority leader of the senate;
new text end

new text begin (2) two members of the house of representatives, one appointed by the speaker of the
house of representatives and one appointed by the minority leader of the house of
representatives;
new text end

new text begin (3) two members appointed by the Association of Minnesota Counties representing
county services in the areas of human services, public health, and corrections or law
enforcement. One of these members must represent counties outside the metropolitan area
defined in Minnesota Statutes, section 473.121, and one of these members must represent
the metropolitan area defined in Minnesota Statutes, section 473.121;
new text end

new text begin (4) one member appointed by the Minnesota American Indian Mental Health Advisory
Council;
new text end

new text begin (5) one member appointed by the Minnesota Medical Association who is a primary care
provider practicing in Minnesota;
new text end

new text begin (6) one member appointed by the NAMI of Minnesota;
new text end

new text begin (7) one member appointed by the Minnesota School Boards Association;
new text end

new text begin (8) one member appointed by the Minnesota Hospital Association to represent hospital
emergency departments;
new text end

new text begin (9) one member appointed by the Minnesota Association of Community Mental Health
Programs to represent rural community mental health centers;
new text end

new text begin (10) one member appointed by the Council of Health Plans;
new text end

new text begin (11) one member from a rural nonprofit foundation with expertise in delivering health
and human services via broadband, appointed by the Blandin Foundation;
new text end

new text begin (12) one member representing child advocacy centers, appointed by the Minnesota Social
Service Association;
new text end

new text begin (13) one member appointed by the Minnesota Social Service Association;
new text end

new text begin (14) one member appointed by the Medical Alley Association;
new text end

new text begin (15) one member appointed by the Minnesota Nurses Association;
new text end

new text begin (16) one member appointed by the chief justice of the supreme court; and
new text end

new text begin (17) the state public defender or a designee.
new text end

new text begin (b) In addition to the members identified in paragraph (a), the task force shall include
the following members as ex officio, nonvoting members:
new text end

new text begin (1) the commissioner of corrections or a designee;
new text end

new text begin (2) the commissioner of human services or a designee;
new text end

new text begin (3) the commissioner of health or a designee; and
new text end

new text begin (4) the commissioner of education or a designee.
new text end

new text begin Subd. 2. new text end

new text begin Appointment deadline; first meeting; chair. new text end

new text begin Appointing authorities must
complete appointments by June 15, 2021. The task force shall select a chair from among
their members at their first meeting. The member appointed by the senate majority leader
shall convene the first meeting of the task force by July 15, 2021.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin The task force shall:
new text end

new text begin (1) explore opportunities for improving behavioral health and other health care service
delivery through the use of a common interoperable person-centered telepresence platform
that provides HIPAA compliant connectivity and technical support to potential users;
new text end

new text begin (2) review and coordinate state and local innovation initiatives and investments designed
to leverage telepresence connectivity and collaboration for Minnesotans;
new text end

new text begin (3) determine standards for a single interoperable telepresence platform;
new text end

new text begin (4) determine statewide capabilities for a single interoperable telepresence platform;
new text end

new text begin (5) identify barriers to providing a telepresence technology, including limited availability
of bandwidth, limitations in providing certain services via telepresence, and broadband
infrastructure needs;
new text end

new text begin (6) identify and make recommendations for governance that will assure person-centered
responsiveness;
new text end

new text begin (7) identify how the business model can be innovated to provide an incentive for ongoing
innovation in Minnesota's health care, human services, education, corrections, and related
ecosystems;
new text end

new text begin (8) identify criteria for suggested deliverables including:
new text end

new text begin (i) equitable statewide access;
new text end

new text begin (ii) evaluating bandwidth availability; and
new text end

new text begin (iii) competitive pricing;
new text end

new text begin (9) identify sustainable financial support for a single telepresence platform, including
infrastructure costs and startup costs for potential users; and
new text end

new text begin (10) identify the benefits to partners in the private sector, state, political subdivisions,
tribal governments, and the constituents they serve in using a common person-centered
telepresence platform for delivering behavioral health services.
new text end

new text begin Subd. 4. new text end

new text begin Administrative support. new text end

new text begin The Legislative Coordinating Commission shall
provide administrative support to the task force. The Legislative Coordinating Commission
may provide meeting space or may use space provided by the Minnesota Social Service
Association for meetings.
new text end

new text begin Subd. 5. new text end

new text begin Per diem; expenses. new text end

new text begin Public members of the task force may be compensated
and have their expenses reimbursed as provided in Minnesota Statutes, section 15.059,
subdivision 3.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin The task force shall report to the chairs and ranking minority members
of the committees in the senate and the house of representatives with primary jurisdiction
over health and state information technology by January 15, 2022, with recommendations
related to expanding the state's telepresence platform and any legislation required to
implement the recommendations.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The task force expires July 31, 2022, or the day after the task force
submits the report required in this section, whichever is earlier.
new text end

Sec. 27. new text beginAPPROPRIATION.
new text end

new text begin $90,000 in fiscal year 2022 is appropriated from the general fund to the Legislative
Coordinating Commission to administer the task force on a public-private telepresence
strategy established in section 26.
new text end

Sec. 28. new text beginREVISOR INSTRUCTION.
new text end

new text begin In Minnesota Statutes and Minnesota Rules, the revisor of statutes shall substitute the
term "telemedicine" with "telehealth" whenever the term appears and substitute Minnesota
Statutes, section 62A.673, whenever references to Minnesota Statutes, sections 62A.67,
62A.671, and 62A.672 appear.
new text end

Sec. 29. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2020, sections 62A.67; 62A.671; and 62A.672, new text end new text begin are repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: S1160-5

62A.67 SHORT TITLE.

Sections 62A.67 to 62A.672 may be cited as the "Minnesota Telemedicine Act."

62A.671 DEFINITIONS.

Subdivision 1.

Applicability.

For purposes of sections 62A.67 to 62A.672, the terms defined in this section have the meanings given.

Subd. 2.

Distant site.

"Distant site" means a site at which a licensed health care provider is located while providing health care services or consultations by means of telemedicine.

Subd. 3.

Health care provider.

"Health care provider" has the meaning provided in section 62A.63, subdivision 2.

Subd. 4.

Health carrier.

"Health carrier" has the meaning provided in section 62A.011, subdivision 2.

Subd. 5.

Health plan.

"Health plan" means a health plan as defined in section 62A.011, subdivision 3, and 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 policyholder.

Subd. 6.

Licensed health care provider.

"Licensed health care provider" means a health care provider who is:

(1) licensed under chapter 147, 147A, 148, 148B, 148E, 148F, 150A, or 153; a mental health professional as defined under section 245.462, subdivision 18, or 245.4871, subdivision 27; or vendor of medical care defined in section 256B.02, subdivision 7; and

(2) authorized within their respective scope of practice to provide the particular service with no supervision or under general supervision.

Subd. 7.

Originating site.

"Originating site" means a site including, but not limited to, a health care facility at which a patient is located at the time health care services are provided to the patient by means of telemedicine.

Subd. 8.

Store-and-forward technology.

"Store-and-forward technology" means the transmission of a patient's medical information from an originating site to a health care provider at a distant site without the patient being present, or the delivery of telemedicine that does not occur in real time via synchronous transmissions.

Subd. 9.

Telemedicine.

"Telemedicine" means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. A communication between licensed health care providers that consists solely of a telephone conversation, e-mail, or facsimile transmission does not constitute telemedicine consultations or services. A communication between a licensed health care provider and a patient that consists solely of an e-mail or facsimile transmission does not constitute telemedicine consultations or services. Telemedicine may be provided by means of real-time two-way, interactive audio and visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient's health care.

62A.672 COVERAGE OF TELEMEDICINE SERVICES.

Subdivision 1.

Coverage of telemedicine.

(a) A health plan sold, issued, or renewed by a health carrier for which coverage of benefits begins on or after January 1, 2017, shall include coverage for telemedicine benefits in the same manner as any other benefits covered under the policy, plan, or contract, and shall comply with the regulations of this section.

(b) Nothing in this section shall be construed to:

(1) require a health carrier to provide coverage for services that are not medically necessary;

(2) prohibit a health carrier from establishing criteria that a health care provider must meet to demonstrate the safety or efficacy of delivering a particular service via telemedicine for which the health carrier does not already reimburse other health care providers for delivering via telemedicine, so long as the criteria are not unduly burdensome or unreasonable for the particular service; or

(3) prevent a health carrier from requiring a health care provider to agree to certain documentation or billing practices designed to protect the health carrier or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular service.

Subd. 2.

Parity between telemedicine and in-person services.

A health carrier shall not exclude a service for coverage solely because the service is provided via telemedicine and is not provided through in-person consultation or contact between a licensed health care provider and a patient.

Subd. 3.

Reimbursement for telemedicine services.

(a) A health carrier shall reimburse the distant site licensed health care provider for covered services delivered via telemedicine on the same basis and at the same rate as the health carrier would apply to those services if the services had been delivered in person by the distant site licensed health care provider.

(b) It is not a violation of this subdivision for a health carrier to include a deductible, co-payment, or coinsurance requirement for a health care service provided via telemedicine, provided that the deductible, co-payment, or coinsurance is not in addition to, and does not exceed, the deductible, co-payment, or coinsurance applicable if the same services were provided through in-person contact.