SF 1369

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to human services; changing provisions for 
  1.3             mental health services; amending Minnesota Statutes 
  1.4             2002, sections 245.462, subdivisions 6, 20; 245.4875, 
  1.5             subdivision 2, by adding a subdivision; 245.4931; 
  1.6             256B.0623, subdivision 5; 256B.0625, subdivision 18, 
  1.7             by adding a subdivision; 256B.761; proposing coding 
  1.8             for new law in Minnesota Statutes, chapters 245; 256B. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2002, section 245.462, 
  1.11  subdivision 6, is amended to read: 
  1.12     Subd. 6.  [COMMUNITY SUPPORT SERVICES PROGRAM.] "Community 
  1.13  support services program" means services, other than inpatient 
  1.14  or residential treatment services, provided or coordinated by an 
  1.15  identified program and staff under the clinical supervision of a 
  1.16  mental health professional designed to help adults with serious 
  1.17  and persistent mental illness to function and remain in the 
  1.18  community.  A community support services program includes: 
  1.19     (1) client outreach, 
  1.20     (2) medication monitoring, 
  1.21     (3) assistance in independent living skills, 
  1.22     (4) development of employability and work-related 
  1.23  opportunities, 
  1.24     (5) crisis assistance, 
  1.25     (6) psychosocial rehabilitation, 
  1.26     (7) help in applying for government benefits, and 
  1.27     (8) housing support services, 
  2.1      (9) education, consultation, and support services provided 
  2.2   to families and other individuals as an extension of the 
  2.3   treatment process, and 
  2.4      (10) transportation of individuals with serious and 
  2.5   persistent mental illness and transportation costs of staff to 
  2.6   the homes of the individuals.  
  2.7      The community support services program must be coordinated 
  2.8   with the case management services specified in section 245.4711. 
  2.9      Sec. 2.  Minnesota Statutes 2002, section 245.462, 
  2.10  subdivision 20, is amended to read: 
  2.11     Subd. 20.  [MENTAL ILLNESS.] (a) "Mental illness" means an 
  2.12  organic disorder of the brain or a clinically significant 
  2.13  disorder of thought, mood, perception, orientation, memory, or 
  2.14  behavior that is listed in the clinical manual of the 
  2.15  International Classification of Diseases (ICD-9-CM), current 
  2.16  edition, code range 290.0 to 302.99 or 306.0 to 316.0 or the 
  2.17  corresponding code in the American Psychiatric Association's 
  2.18  Diagnostic and Statistical Manual of Mental Disorders (DSM-MD), 
  2.19  current edition, Axes I, II, or III, and that seriously limits a 
  2.20  person's capacity to function in primary aspects of daily living 
  2.21  such as personal relations, living arrangements, work, and 
  2.22  recreation.  
  2.23     (b) An "adult with acute mental illness" means an adult who 
  2.24  has a mental illness that is serious enough to require prompt 
  2.25  intervention.  
  2.26     (c) For purposes of case management and community support 
  2.27  services, a "person with serious and persistent mental illness" 
  2.28  means an adult who has a mental illness and meets at least one 
  2.29  of the following criteria: 
  2.30     (1) the adult has undergone two or more episodes of 
  2.31  inpatient care for a mental illness within the preceding 24 
  2.32  months; 
  2.33     (2) the adult has experienced a continuous psychiatric 
  2.34  hospitalization or residential treatment exceeding six months' 
  2.35  duration within the preceding 12 months; 
  2.36     (3) the adult: 
  3.1      (i) has a diagnosis of schizophrenia, bipolar disorder, 
  3.2   major depression, or borderline personality disorder, or severe 
  3.3   anxiety disorder such as panic disorder, obsessive-compulsive 
  3.4   disorder, post-traumatic stress disorder, and social anxiety 
  3.5   disorder; 
  3.6      (ii) indicates a significant impairment in functioning; and 
  3.7      (iii) has a written opinion from a mental health 
  3.8   professional, in the last three years, stating that the adult is 
  3.9   reasonably likely to have future episodes requiring inpatient or 
  3.10  residential treatment, of a frequency described in clause (1) or 
  3.11  (2), unless ongoing case management or community support 
  3.12  services are provided; 
  3.13     (4) the adult has, in the last three years, been committed 
  3.14  by a court as a person who is mentally ill under chapter 253B, 
  3.15  or the adult's commitment has been stayed or continued; or 
  3.16     (5) the adult (i) was eligible under clauses (1) to (4), 
  3.17  but the specified time period has expired or the adult was 
  3.18  eligible as a child under section 245.4871, subdivision 6; and 
  3.19  (ii) has a written opinion from a mental health professional, in 
  3.20  the last three years, stating that the adult is reasonably 
  3.21  likely to have future episodes requiring inpatient or 
  3.22  residential treatment, of a frequency described in clause (1) or 
  3.23  (2), unless ongoing case management or community support 
  3.24  services are provided; or 
  3.25     (6) the adult is between the ages of 18 and 25 and as a 
  3.26  child was:  (i) eligible for services under sections 245.487 to 
  3.27  245.4888 as a child with severe emotional disturbance, as 
  3.28  defined in section 245.4871, subdivision 6; or (ii) eligible for 
  3.29  special education services under the Individuals with 
  3.30  Disabilities Education Act or chapter 125A as a child with an 
  3.31  emotional or behavioral disorder, as defined in Minnesota Rules, 
  3.32  part 3525.1329, subpart 1. 
  3.33     Sec. 3.  Minnesota Statutes 2002, section 245.4875, 
  3.34  subdivision 2, is amended to read: 
  3.35     Subd. 2.  [CHILDREN'S MENTAL HEALTH SERVICES.] The 
  3.36  children's mental health service system developed by each county 
  4.1   board must include the following services:  
  4.2      (1) education and prevention services according to section 
  4.3   245.4877; 
  4.4      (2) mental health identification and intervention services 
  4.5   according to section 245.4878; 
  4.6      (3) emergency services according to section 245.4879; 
  4.7      (4) outpatient services according to section 245.488; 
  4.8      (5) family community support services according to section 
  4.9   245.4881; 
  4.10     (6) day treatment services according to section 245.4884, 
  4.11  subdivision 2; 
  4.12     (7) residential treatment services according to section 
  4.13  245.4882; 
  4.14     (8) acute care hospital inpatient treatment services 
  4.15  according to section 245.4883; 
  4.16     (9) screening according to section 245.4885; 
  4.17     (10) case management according to section 245.4881; 
  4.18     (11) therapeutic support of foster care according to 
  4.19  section 245.4884, subdivision 4; 
  4.20     (12) professional home-based family treatment according to 
  4.21  section 245.4884, subdivision 4; and 
  4.22     (13) mental health crisis services according to section 
  4.23  245.488, subdivision 3; and 
  4.24     (14) respite care. 
  4.25     Sec. 4.  Minnesota Statutes 2002, section 245.4875, is 
  4.26  amended by adding a subdivision to read: 
  4.27     Subd. 2a.  [RESPITE CARE PROVIDERS AND TRAINING.] Counties 
  4.28  shall recruit respite care providers and provide training on: 
  4.29     (1) medication and side effects; 
  4.30     (2) behavior management; 
  4.31     (3) child development; 
  4.32     (4) child mental health diagnoses and treatment including 
  4.33  autism, fetal alcohol syndrome, and fetal alcohol effect; 
  4.34     (5) available community resources for specific mental 
  4.35  health diagnoses including fetal alcohol syndrome and fetal 
  4.36  alcohol effect; and 
  5.1      (6) de-escalation methods and violence prevention 
  5.2   strategies. 
  5.3      Sec. 5.  Minnesota Statutes 2002, section 245.4931, is 
  5.4   amended to read: 
  5.5      245.4931 [INTEGRATED LOCAL SERVICE SYSTEM.] 
  5.6      The integrated service system established by the local 
  5.7   children's mental health collaborative must: 
  5.8      (1) include a process for communicating to agencies in the 
  5.9   local system of care eligibility criteria for services received 
  5.10  through the local children's mental health collaborative and a 
  5.11  process for determining eligibility.  The process shall place 
  5.12  strong emphasis on outreach to families, respecting the family 
  5.13  role in identifying children in need, and valuing families as 
  5.14  partners; 
  5.15     (2) include measurable outcomes, timelines for evaluating 
  5.16  progress, and mechanisms for quality assurance and appeals; 
  5.17     (3) involve the family, and where appropriate the 
  5.18  individual child, in developing multiagency service plans to the 
  5.19  extent required in sections 125A.08; 245.4871, subdivision 21; 
  5.20  245.4881, subdivision 4; 253B.03, subdivision 7; 260C.212, 
  5.21  subdivision 1; and 260C.201, subdivision 6; 
  5.22     (4) meet all standards and provide all mental health 
  5.23  services as required in sections 245.487 to 245.4888, and ensure 
  5.24  that the services provided are culturally appropriate; 
  5.25     (5) spend funds generated by the local children's mental 
  5.26  health collaborative as required in sections 245.491 to 245.496; 
  5.27     (6) encourage public-private partnerships to increase 
  5.28  efficiency, reduce redundancy, and promote quality of care; and 
  5.29     (7) ensure that, if the county participant of the local 
  5.30  children's mental health collaborative is also a provider of 
  5.31  child welfare targeted case management as authorized by the 1993 
  5.32  legislature, then federal reimbursement received by the county 
  5.33  for child welfare targeted case management provided to children 
  5.34  served by the local children's mental health collaborative must 
  5.35  be directed to the integrated fund; and 
  5.36     (8) establish a program to recruit and train respite care 
  6.1   providers for children with complex and challenging mental 
  6.2   health and behavioral issues. 
  6.3      Sec. 6.  [245.735] [ANNUAL RATE ADJUSTMENTS.] 
  6.4      Subdivision 1.  [PROVISION OF RATE INCREASES.] Beginning 
  6.5   July 1, 2003, and each July 1 thereafter, the commissioner of 
  6.6   human services shall increase reimbursement rates for adult 
  6.7   residential program grants under Minnesota Rules, parts 
  6.8   9535.2000 to 9535.3000, and adult and family community support 
  6.9   grants under Minnesota Rules, parts 9535.1700 to 9535.1760, by 
  6.10  the percentage change in the Consumer Price Index for urban 
  6.11  consumers (CPI) for the previous calendar year. 
  6.12     Subd. 2.  [USE OF INCREASE.] Providers that receive a rate 
  6.13  increase under this section shall use at least 80 percent of the 
  6.14  additional revenue to increase the compensation paid to 
  6.15  employees other than the administrator and central office staff. 
  6.16     Subd. 3.  [PROVIDER PLAN.] A copy of the provider's plan 
  6.17  for complying with subdivision 2 must be made available to all 
  6.18  employees.  This must be done by giving each employee a copy or 
  6.19  by posting it in an area of the provider's operation to which 
  6.20  all employees have access.  If an employee does not receive the 
  6.21  compensation adjustment described in the plan and is unable to 
  6.22  resolve the problem with the provider, the employee may contact 
  6.23  the employee's union representative.  If the employee is not 
  6.24  covered by a collective bargaining agreement, the employee may 
  6.25  contact the commissioner at a telephone number provided by the 
  6.26  commissioner and included in the provider's plan. 
  6.27     Subd. 4.  [STAGED RATE ADJUSTMENT.] (a) Beginning July 1, 
  6.28  2003, and each July 1 through July 1, 2006, the commissioner of 
  6.29  human services shall increase reimbursement rates for adult 
  6.30  residential program grants under Minnesota Rules, parts 
  6.31  9535.2000 to 9535.3000, and adult and family community support 
  6.32  grants under Minnesota Rules, parts 9535.1700 to 9535.1760, by 
  6.33  one-fourth of the percentage change in the Consumer Price Index 
  6.34  for urban consumers (CPI) between January 1, 1990, and December 
  6.35  31, 2000. 
  6.36     (b) Providers that receive a rate increase under this 
  7.1   section must use at least 80 percent of the additional revenue 
  7.2   to increase the compensation paid to employees other than the 
  7.3   administrator and central office staff. 
  7.4      (c) A copy of the provider's plan for complying with 
  7.5   paragraph (b) must be made available to all employees and meet 
  7.6   the requirements of subdivision 3. 
  7.7      Sec. 7.  Minnesota Statutes 2002, section 256B.0623, 
  7.8   subdivision 5, is amended to read: 
  7.9      Subd. 5.  [QUALIFICATIONS OF PROVIDER STAFF.] Adult 
  7.10  rehabilitative mental health services must be provided by 
  7.11  qualified individual provider staff of a certified provider 
  7.12  entity.  Individual provider staff must be qualified under one 
  7.13  of the following criteria: 
  7.14     (1) a mental health professional as defined in section 
  7.15  245.462, subdivision 18, clauses (1) to (5).  For purposes of 
  7.16  this section and Minnesota Rules, parts 9505.0170 to 9505.0475, 
  7.17  the definition of a mental health professional also means a 
  7.18  person who is qualified as specified in section 245.462, 
  7.19  subdivision 18, clause (6), and holds a current and valid 
  7.20  national certification as a certified rehabilitation counselor 
  7.21  or certified psychosocial rehabilitation practitioner; 
  7.22     (2) a mental health practitioner as defined in section 
  7.23  245.462, subdivision 17.  The mental health practitioner must 
  7.24  work under the clinical supervision of a mental health 
  7.25  professional; or 
  7.26     (3) a mental health rehabilitation worker.  A mental health 
  7.27  rehabilitation worker means a staff person working under the 
  7.28  direction of a mental health practitioner or mental health 
  7.29  professional and under the clinical supervision of a mental 
  7.30  health professional in the implementation of rehabilitative 
  7.31  mental health services as identified in the recipient's 
  7.32  individual treatment plan who: 
  7.33     (i) is at least 21 years of age; 
  7.34     (ii) has a high school diploma or equivalent; 
  7.35     (iii) has successfully completed 30 hours of training 
  7.36  during the past two years in all of the following areas:  
  8.1   recipient rights, recipient-centered individual treatment 
  8.2   planning, behavioral terminology, mental illness, co-occurring 
  8.3   mental illness and substance abuse, psychotropic medications and 
  8.4   side effects, functional assessment, local community resources, 
  8.5   adult vulnerability, recipient confidentiality; and 
  8.6      (iv) meets the qualifications in subitem (A) or (B): 
  8.7      (A) has an associate of arts degree in one of the 
  8.8   behavioral sciences or human services, or is a registered nurse 
  8.9   without a bachelor's degree, or who within the previous ten 
  8.10  years has:  
  8.11     (1) three years of personal life experience with serious 
  8.12  and persistent mental illness; 
  8.13     (2) three years of life experience as a primary caregiver 
  8.14  to an adult with a serious mental illness or traumatic brain 
  8.15  injury; or 
  8.16     (3) 4,000 hours of supervised paid work experience in the 
  8.17  delivery of mental health services to adults with a serious 
  8.18  mental illness or traumatic brain injury; or 
  8.19     (B)(1) is fluent in the non-English language or competent 
  8.20  in the culture of the ethnic group to which at least 50 percent 
  8.21  of the mental health rehabilitation worker's clients belong; 
  8.22     (2) receives during the first 2,000 hours of work, monthly 
  8.23  documented individual clinical supervision by a mental health 
  8.24  professional; 
  8.25     (3) has 18 hours of documented field supervision by a 
  8.26  mental health professional or practitioner during the first 160 
  8.27  hours of contact work with recipients, and at least six hours of 
  8.28  field supervision quarterly during the following year; 
  8.29     (4) has review and cosignature of charting of recipient 
  8.30  contacts during field supervision by a mental health 
  8.31  professional or practitioner; and 
  8.32     (5) has 40 hours of additional continuing education on 
  8.33  mental health topics during the first year of employment. 
  8.34     Sec. 8.  Minnesota Statutes 2002, section 256B.0625, 
  8.35  subdivision 18, is amended to read: 
  8.36     Subd. 18.  [BUS OR TAXICAB TRANSPORTATION.] To the extent 
  9.1   authorized by rule of the state agency, medical assistance 
  9.2   covers costs of the most appropriate and cost-effective form of 
  9.3   transportation incurred by any ambulatory eligible person for 
  9.4   obtaining nonemergency medical care including staff 
  9.5   transportation costs of home visits to persons with a serious 
  9.6   and persistent mental illness as defined in section 245.462, 
  9.7   subdivision 20, paragraph (c), clause (3). 
  9.8      Sec. 9.  Minnesota Statutes 2002, section 256B.0625, is 
  9.9   amended by adding a subdivision to read: 
  9.10     Subd. 45.  [MENTAL HEALTH EVALUATION AND MANAGEMENT; 
  9.11  CLINICAL SUPERVISION.] (a) Medical assistance covers the 
  9.12  following evaluation and management services related to mental 
  9.13  health symptoms, treatment, and supportive services: 
  9.14     (1) outpatient services performed by mental health 
  9.15  professionals in community mental health centers under 
  9.16  subdivision 5 or community health clinics under section 245.62 
  9.17  and Minnesota Rules, part 9505.0255, public health clinics under 
  9.18  Minnesota Rules, part 9505.0380, or mental health centers and 
  9.19  mental health clinics certified under Minnesota Rules, parts 
  9.20  9520.0750 to 9520.0870; 
  9.21     (2) inpatient evaluation and management services performed 
  9.22  by psychiatrists for day treatment, partial hospitalization, 
  9.23  crisis intervention, and nonresidential crisis stabilization 
  9.24  services; and 
  9.25     (3) consultation, evaluation, and management services 
  9.26  provided via telemedicine. 
  9.27     (b) Medical assistance covers clinical supervision services 
  9.28  that are required as a condition of payment for services 
  9.29  provided under subdivisions 3 and 5, and Minnesota Rules, parts 
  9.30  9505.0323, 9505.0324, and 9505.0326. 
  9.31     (c) Medical assistance covers consultation to families and 
  9.32  consultation with providers who are culturally competent. 
  9.33     Sec. 10.  Minnesota Statutes 2002, section 256B.761, is 
  9.34  amended to read: 
  9.35     256B.761 [REIMBURSEMENT FOR MENTAL HEALTH SERVICES.] 
  9.36     (a) Effective for services rendered on or after July 1, 
 10.1   2001, payment for medication management provided to psychiatric 
 10.2   patients, outpatient mental health services, day treatment 
 10.3   services, home-based mental health services, and family 
 10.4   community support services shall be paid at the lower of (1) 
 10.5   submitted charges, or (2) 75.6 percent of the 50th percentile of 
 10.6   1999 2001 charges. 
 10.7      (b) For outpatient and rehabilitative mental health 
 10.8   services that use health care payment system or local procedure 
 10.9   codes, the commissioner shall rebase the reimbursement rates to 
 10.10  the greater of the 80th percentile of submitted charges of the 
 10.11  provider's reasonable cost of care.  Any increase must be 
 10.12  reflected under prepaid medical assistance program contracts for 
 10.13  those services. 
 10.14     Sec. 11.  [256B.762] [MENTAL HEALTH CLINIC REIMBURSEMENT.] 
 10.15     Subdivision 1.  [RATE INCREASE.] Effective for services 
 10.16  rendered on or after July 1, 2003, payment rates for:  
 10.17     (1) community mental health center services under section 
 10.18  256B.0625, subdivision 5; 
 10.19     (2) services provided by mental health clinics and centers 
 10.20  certified under Minnesota Rules, parts 9520.0750 to 9520.0870, 
 10.21  or hospital outpatient psychiatric departments designated as 
 10.22  essential community providers under section 62Q.19; and 
 10.23     (3) services provided by mental health clinics and centers 
 10.24  certified under Minnesota Rules, parts 9520.0750 to 9520.0870, 
 10.25  or hospital outpatient psychiatric departments, that receive at 
 10.26  least 30 percent of their revenue from contracts with a county 
 10.27  or counties to provide services under the adult and children's 
 10.28  mental health acts, shall be increased by 20 percent over the 
 10.29  rates in effect on June 30, 2001.  This reimbursement increase 
 10.30  shall be in addition to any other reimbursement increases 
 10.31  enacted by the legislature in 2001 and 2002. 
 10.32     Subd. 2.  [SETTLE-UP.] Beginning July 1, 2003, the 
 10.33  commissioner shall implement a settle-up procedure to pay 
 10.34  community mental health centers and mental health clinics and 
 10.35  centers for services provided to prepaid medical assistance, 
 10.36  prepaid general assistance medical care, and MinnesotaCare 
 11.1   enrollees.  The settle-up procedure must pay community mental 
 11.2   health centers and mental health clinics and centers the 
 11.3   difference between the state health care program reimbursement 
 11.4   rate and the reimbursement received from the prepaid health 
 11.5   plan.  The settle-up procedure must be based on that used by the 
 11.6   commissioner to reimburse federally qualified health centers and 
 11.7   rural health clinics.