SF 1321

1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/09/2021 09:33am

A bill for an act
relating to human services; establishing intensive in-home children's mental health
stabilization and support services; permitting intensive treatment in foster care
service delivery across more than three days per week; requiring the commissioner
of human services to establish a weekly per-client encounter rate for intensive
treatment in foster care services; instructing the commissioner to identify existing
and emerging federal matching funds for intensive children's mental health services
and supports; amending Minnesota Statutes 2020, section 256B.0946, subdivisions
4, 7; proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

new text begin [256B.0942] INTENSIVE IN-HOME CHILDREN'S MENTAL HEALTH
STABILIZATION AND SUPPORT SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given them.
new text end

new text begin (b) "Clinical care consultation and coordination" means communication from a treating
clinician to other providers working with the same client to inform, inquire, and instruct
regarding the client's symptoms, strategies for effective client and family engagement, care
and intervention needs, and treatment expectations across service settings and to direct and
coordinate clinical service components provided to the client and family.
new text end

new text begin (c) "Clinical coordinator" means an individual who builds and sustains relationships
with a client and family and is responsible for supporting and coordinating the
implementation of the client's individual treatment plan, in cooperation with the client's
intensive service team. A client's county case manager may serve as the client's clinical
coordinator.
new text end

new text begin (d) "Clinical supervision" means the documented time a clinical supervisor and supervisee
spend together to discuss the supervisee's work, to review individual client cases, and for
the supervisee's professional development. Clinical supervision includes the documented
oversight and supervision responsibility for planning, implementing, and evaluating services
for a client's mental health treatment.
new text end

new text begin (e) "Clinical supervisor" means the mental health professional who is responsible for
clinical supervision.
new text end

new text begin (f) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371, subpart
5, item C.
new text end

new text begin (g) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a,
including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis. Crisis assistance does not include actual crisis intervention.
new text end

new text begin (h) "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370,
subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.
new text end

new text begin (i) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 9505.0370,
subpart 11.
new text end

new text begin (j) "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include but
is not limited to parents, children, spouse, committed partners, former spouses, persons
related by blood or adoption, or persons who are presently residing together as a family
unit.
new text end

new text begin (k) "Family peer specialist" means a staff person qualified under section 256B.0616.
new text end

new text begin (l) "Homemaking assistance services" means services that assist a family with general
cleaning and household management activities.
new text end

new text begin (m) "Individual treatment plan" has the meaning given in Minnesota Rules, part
9505.0370, subpart 15.
new text end

new text begin (n) "Intensive service team" means all mental health professionals and other service
providers working with the client, the clinical coordinator, and the client's family. The
intensive service team may also include an individualized education program case manager,
probation agent, or children's mental health case manager.
new text end

new text begin (o) "Mental health professional" has the meaning given in section 245.4871, subdivision
27.
new text end

new text begin (p) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370, subpart
20.
new text end

new text begin (q) "Parent" has the meaning given in section 245.4871, subdivision 30.
new text end

new text begin (r) "Psychoeducation services" means information or demonstrations provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, out-of-home placement, or the acquisition
of comorbid disorders, and achieve optimal mental health and long-term resilience.
new text end

new text begin (s) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370, subpart
27.
new text end

new text begin (t) "Respite care" has the meaning given in section 245.492, subdivision 17.
new text end

new text begin (u) "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among the intensive service team in a group concerning the treatment
needs of the child, including disseminating the child's treatment service schedule to all
members of the intensive service team.
new text end

new text begin Subd. 2. new text end

new text begin Required covered service components. new text end

new text begin (a) Subject to federal approval, medical
assistance covers medically necessary intensive in-home children's mental health stabilization
and support services described in paragraph (b) that an eligible provider entity under
subdivision 4 provides to an eligible client, as defined in subdivision 3, when the services
are provided by an entity meeting the standards in this section.
new text end

new text begin (b) Intensive in-home children's mental health stabilization and support services
reimbursed by medical assistance must include the following, as needed by the individual
client:
new text end

new text begin (1) psychotherapy provided by a mental health professional or a clinical trainee under
clinical supervision;
new text end

new text begin (2) individual, family, and group psychoeducation services;
new text end

new text begin (3) clinical care consultation and coordination;
new text end

new text begin (4) crisis assistance provided according to standards for children's therapeutic services
and supports in section 256B.0943;
new text end

new text begin (5) family respite care;
new text end

new text begin (6) family peer specialist services;
new text end

new text begin (7) homemaking assistance services;
new text end

new text begin (8) transportation costs related to the provision of necessary services; and
new text end

new text begin (9) on-call, after-hours client support services.
new text end

new text begin Subd. 3. new text end

new text begin Client eligibility. new text end

new text begin (a) An eligible client is an individual, from birth through age
20, who is currently living in the client's home and has received a diagnostic assessment
and an evaluation of level of care needed, as defined in paragraphs (b) and (c).
new text end

new text begin (b) The diagnostic assessment must:
new text end

new text begin (1) meet the criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
conducted by a mental health professional or a clinical trainee;
new text end

new text begin (2) determine whether a child meets the criteria for mental illness;
new text end

new text begin (3) document that intensive in-home mental health stabilization and support services are
necessary to ameliorate identified symptoms and functional impairments and prevent
out-of-home placement;
new text end

new text begin (4) be performed within 180 days before the start of service; and
new text end

new text begin (5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
new text end

new text begin (c) The evaluation of level of care must be conducted by the placing county, tribe, or
case manager in conjunction with the diagnostic assessment as described by Minnesota
Rules, part 9505.0372, subpart 1, item B, using a validated tool approved by the
commissioner of human services and not subject to the rulemaking process, consistent with
section 245.4885, subdivision 1, paragraph (d), the result of which demonstrates that the
child requires intensive intervention without 24-hour medical monitoring. The commissioner
shall update the list of approved validated tools annually and publish the list on the
department's website.
new text end

new text begin Subd. 4. new text end

new text begin Eligible providers. new text end

new text begin (a) Eligible providers for intensive in-home children's
mental health stabilization and support services must be licensed or certified by the state
and have a service provision contract with the commissioner to provide intensive in-home
children's mental health stabilization and support services. Eligible providers must be able
to demonstrate the ability to provide all the services required in this section.
new text end

new text begin (b) For purposes of this section, an eligible provider must be:
new text end

new text begin (1) a county-operated entity certified by the state;
new text end

new text begin (2) an Indian Health Services provider operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
new text end

new text begin (3) a noncounty entity.
new text end

new text begin (c) The commissioner shall develop performance evaluation criteria for eligible providers
and may require applicants and eligible providers to submit documentation as needed to
allow the commissioner to determine whether the criteria are met.
new text end

new text begin (d) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.
new text end

new text begin Subd. 5. new text end

new text begin Service delivery payment requirements. new text end

new text begin (a) To be eligible for payment under
this section an eligible provider must develop and practice written policies and procedures
for intensive in-home children's mental health stabilization and support services, consistent
with subdivision 2, paragraph (b), and comply with the requirements in paragraphs (b) to
(m).
new text end

new text begin (b) A qualified clinical supervisor must supervise the treatment and provision of services
described in this section.
new text end

new text begin (c) Each client receiving services under this section must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
new text end

new text begin (d) Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
diagnostic assessment and team consultation and treatment planning review process.
new text end

new text begin (e) Each client receiving services must be assessed for a trauma history, and the client's
individual treatment plan must document how the results of the assessment will be
incorporated into treatment.
new text end

new text begin (f) Each client receiving services must have an individual treatment plan that is reviewed,
evaluated, and signed every 90 days using the team consultation and treatment planning
process.
new text end

new text begin (g) Care consultation and coordination must be provided in accordance with the client's
individual treatment plan.
new text end

new text begin (h) Each client must have a crisis assistance plan within ten days of initiating services
and must have access to after-hours, on-call clinical support during the course of treatment.
The crisis plan must demonstrate coordination with the local or regional mobile crisis
intervention team.
new text end

new text begin (i) Services must be documented in compliance with Minnesota Rules, parts 9505.2175
and 9505.2197.
new text end

new text begin (j) Location of service delivery must be in the client's home, day care setting, school, or
other community-based setting that is specified on the client's individualized treatment plan.
new text end

new text begin (k) Treatment must be developmentally and culturally appropriate for the client.
new text end

new text begin (l) Services must be delivered in continual collaboration and consultation with the client's
family and medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the intensive service team
must be aware of the medication regimen and potential side effects.
new text end

new text begin (m) Transition planning for the child must be conducted starting with the first individual
treatment plan and must be addressed throughout the provision of services to support the
child's postdischarge mental health service needs.
new text end

new text begin Subd. 6. new text end

new text begin Medical assistance payment and rate setting. new text end

new text begin The commissioner shall establish
a single weekly per-client encounter rate for intensive in-home children's mental health
stabilization and support services. The rate must be constructed to cover only eligible services
delivered to an eligible client by an eligible provider, as prescribed in subdivision 2,
paragraph (b), and must include all services, supports, and related activities, and intensive
service team member travel time and mileage to provide services under this section.
new text end

new text begin Subd. 7. new text end

new text begin Excluded services. new text end

new text begin (a) The following services are not covered under this section
and are not eligible for medical assistance payments as components of intensive in-home
children's mental health stabilization and support services, but may be billed separately:
new text end

new text begin (1) inpatient psychiatric hospital treatment;
new text end

new text begin (2) mental health targeted case management;
new text end

new text begin (3) partial hospitalization;
new text end

new text begin (4) medication management;
new text end

new text begin (5) children's mental health day treatment services; and
new text end

new text begin (6) crisis response services under section 256B.0944.
new text end

new text begin (b) Children receiving intensive in-home mental health stabilization and support services
are not eligible for medical assistance reimbursement for the following services while
receiving intensive in-home mental health stabilization and support services:
new text end

new text begin (1) psychotherapy and skills training components of children's therapeutic services and
supports under section 256B.0625, subdivision 35b;
new text end

new text begin (2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph (m);
new text end

new text begin (3) home and community-based waiver services;
new text end

new text begin (4) mental health residential treatment;
new text end

new text begin (5) room and board costs as defined in section 256I.03, subdivision 6; and
new text end

new text begin (6) intensive treatment in foster care services under section 256B.0946.
new text end

new text begin Subd. 8. new text end

new text begin Service authorization. new text end

new text begin The commissioner shall administer authorizations for
services under this section in compliance with section 256B.0625, subdivision 25.
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. 2.

Minnesota Statutes 2020, section 256B.0946, subdivision 4, is amended to read:

Subd. 4.

Service delivery payment requirements.

(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment in foster care, consistent with subdivision 1, paragraph (b), and comply
with the following requirements in paragraphs (b) to (n).

(b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.

(c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.

(d) Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
diagnostic assessment and team consultation and treatment planning review process.

(e) Each client receiving treatment must be assessed for a trauma history, and the client's
treatment plan must document how the results of the assessment will be incorporated into
treatment.

(f) Each client receiving treatment services must have an individual treatment plan that
is reviewed, evaluated, and signed every 90 days using the team consultation and treatment
planning process, as defined in subdivision 1a, paragraph (s).

(g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided in
accordance with the client's individual treatment plan.

(h) Each client must have a crisis assistance plan within ten days of initiating services
and must have access to clinical phone support 24 hours per day, seven days per week,
during the course of treatment. The crisis plan must demonstrate coordination with the local
or regional mobile crisis intervention team.

(i) Services must be delivered and documented at least new text begin , but not limited to, new text end three days
per week, equaling at least six hours of treatment per week, unless reduced units of service
are specified on the treatment plan as part of transition or on a discharge plan to another
service or level of care. Documentation must comply with Minnesota Rules, parts 9505.2175
and 9505.2197.

(j) Location of service delivery must be in the client's home, day care setting, school, or
other community-based setting that is specified on the client's individualized treatment plan.

(k) Treatment must be developmentally and culturally appropriate for the client.

(l) Services must be delivered in continual collaboration and consultation with the client's
medical providers and, in particular, with prescribers of psychotropic medications, including
those prescribed on an off-label basis. Members of the service team must be aware of the
medication regimen and potential side effects.

(m) Parents, siblings, foster parents, and members of the child's permanency plan must
be involved in treatment and service delivery unless otherwise noted in the treatment plan.

(n) Transition planning for the child must be conducted starting with the first treatment
plan and must be addressed throughout treatment to support the child's permanency plan
and postdischarge mental health service needs.

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2020, section 256B.0946, subdivision 7, is amended to read:

Subd. 7.

Medical assistance payment and rate setting.

The commissioner shall establish
a single deleted text begin daily deleted text end new text begin weekly new text end per-client encounter rate for intensive treatment in foster care services.
The rate must be constructed to cover only eligible services delivered to an eligible recipient
by an eligible provider, as prescribed in subdivision 1, paragraph (b).

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. new text begin DIRECTION TO THE COMMISSIONER; FEDERAL MATCHING FUNDS.
new text end

new text begin The commissioner of human services shall collaborate with children's mental health
providers and experts to identify existing and emerging federal matching funds through
medical assistance and the federal Title IV-E Prevention Services Clearinghouse to provide
intensive children's mental health services and supports that focus on family preservation
and deliver individualized treatment to clients.
new text end