SF 1504

1st Unofficial Engrossment - 86th Legislature (2009 - 2010) Posted on 12/26/2012 11:17pm

1.1A bill for an act

1.2relating to human services; amending mental health provisions; changing
1.3medical assistance reimbursement and eligibility; changing provider qualification
1.4and training requirements; amending mental health behavioral aide services;
1.5providing coverage of mental health behavioral aide services; changing special
1.6contracts with bordering states; requiring a new rate setting methodology;
1.7amending Minnesota Statutes 2008, sections 148C.11, subdivision 1; 245.4871,
1.8subdivision 26; 245.4885, subdivision 1; 245.50, subdivision 5; 256B.0615,
1.9subdivisions 1, 3; 256B.0622, subdivision 8; 256B.0623, subdivision 5;
1.10256B.0624, subdivision 8; 256B.0625, subdivision 49; 256B.0943, subdivisions
1.111, 2, 4, 5, 6, 7, 9; 256B.0944, subdivision 5.
1.12BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.13    Section 1. Minnesota Statutes 2008, section 148C.11, subdivision 1, is amended to read:
1.14    Subdivision 1. Other professionals. (a) Nothing in this chapter prevents members
1.15of other professions or occupations from performing functions for which they are qualified
1.16or licensed. This exception includes, but is not limited to: licensed physicians; registered
1.17nurses; licensed practical nurses; licensed psychological practitioners; members of
1.18the clergy; American Indian medicine men and women; licensed attorneys; probation
1.19officers; licensed marriage and family therapists; licensed social workers; social workers
1.20employed by city, county, or state agencies; licensed professional counselors; licensed
1.21school counselors; registered occupational therapists or occupational therapy assistants;
1.22city, county, or state employees when providing assessments or case management under
1.23Minnesota Rules, chapter 9530; and until July 1, 2009, individuals providing integrated
1.24dual-diagnosis treatment in adult mental health rehabilitative programs certified by the
1.25Department of Human Services under section 256B.0622 or 256B.0623.
2.1    (b) Nothing in this chapter prohibits technicians and resident managers in programs
2.2licensed by the Department of Human Services from discharging their duties as provided
2.3in Minnesota Rules, chapter 9530.
2.4    (c) Any person who is exempt under this subdivision but who elects to obtain a
2.5license under this chapter is subject to this chapter to the same extent as other licensees.
2.6The board shall issue a license without examination to an applicant who is licensed or
2.7registered in a profession identified in paragraph (a) if the applicant:
2.8    (1) shows evidence of current licensure or registration; and
2.9    (2) has submitted to the board a plan for supervision during the first 2,000 hours of
2.10professional practice or has submitted proof of supervised professional practice that is
2.11acceptable to the board.
2.12    (d) Any person who is exempt from licensure under this section must not use a
2.13title incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
2.14counselor" or otherwise hold themselves out to the public by any title or description
2.15stating or implying that they are engaged in the practice of alcohol and drug counseling,
2.16or that they are licensed to engage in the practice of alcohol and drug counseling unless
2.17that person is also licensed as an alcohol and drug counselor. Persons engaged in the
2.18practice of alcohol and drug counseling are not exempt from the board's jurisdiction
2.19solely by the use of one of the above titles.

2.20    Sec. 2. Minnesota Statutes 2008, section 245.4871, subdivision 26, is amended to read:
2.21    Subd. 26. Mental health practitioner. "Mental health practitioner" means a person
2.22providing services to children with emotional disturbances. A mental health practitioner
2.23must have training and experience in working with children. A mental health practitioner
2.24must be qualified in at least one of the following ways:
2.25(1) holds a bachelor's degree in one of the behavioral sciences or related fields from
2.26an accredited college or university and:
2.27(i) has at least 2,000 hours of supervised experience in the delivery of mental health
2.28services to children with emotional disturbances; or
2.29(ii) is fluent in the non-English language of the ethnic group to which at least 50
2.30percent of the practitioner's clients belong, completes 40 hours of training in the delivery
2.31of services to children with emotional disturbances, and receives clinical supervision from
2.32a mental health professional at least once a week until the requirement of 2,000 hours
2.33of supervised experience is met;
2.34(2) has at least 6,000 hours of supervised experience in the delivery of mental
2.35health services to children with emotional disturbances; hours worked as a mental health
3.1behavioral aide I or II under section 256B.0943, subdivision 7, may be included in the
3.26,000 hours of experience;
3.3(3) is a graduate student in one of the behavioral sciences or related fields and is
3.4formally assigned by an accredited college or university to an agency or facility for
3.5clinical training; or
3.6(4) holds a master's or other graduate degree in one of the behavioral sciences or
3.7related fields from an accredited college or university and has less than 4,000 hours
3.8post-master's experience in the treatment of emotional disturbance.

3.9    Sec. 3. Minnesota Statutes 2008, section 245.4885, subdivision 1, is amended to read:
3.10    Subdivision 1. Admission criteria. The county board shall, prior to admission,
3.11except in the case of emergency admission, determine the needed level of care for all
3.12children referred for treatment of severe emotional disturbance in a treatment foster care
3.13setting, residential treatment facility, or informally admitted to a regional treatment center
3.14if public funds are used to pay for the services. The county board shall also determine the
3.15needed level of care for all children admitted to an acute care hospital for treatment of
3.16severe emotional disturbance if public funds other than reimbursement under chapters
3.17256B and 256D are used to pay for the services. The level of care determination shall
3.18determine whether the proposed treatment:
3.19(1) is necessary;
3.20(2) is appropriate to the child's individual treatment needs;
3.21(3) cannot be effectively provided in the child's home; and
3.22(4) provides a length of stay as short as possible consistent with the individual
3.23child's need.
3.24When a level of care determination is conducted, the county board may not
3.25determine that referral or admission to a treatment foster care setting, or residential
3.26treatment facility, or acute care hospital is not appropriate solely because services were
3.27not first provided to the child in a less restrictive setting and the child failed to make
3.28progress toward or meet treatment goals in the less restrictive setting. The level of care
3.29determination must be based on a diagnostic assessment that includes a functional
3.30assessment which evaluates family, school, and community living situations; and an
3.31assessment of the child's need for care out of the home using a validated tool which
3.32assesses a child's functional status and assigns an appropriate level of care. The validated
3.33tool must be approved by the commissioner of human services. If a diagnostic assessment
3.34including a functional assessment has been completed by a mental health professional
3.35within the past 180 days, a new diagnostic assessment need not be completed unless in the
4.1opinion of the current treating mental health professional the child's mental health status
4.2has changed markedly since the assessment was completed. The child's parent shall be
4.3notified if an assessment will not be completed and of the reasons. A copy of the notice
4.4shall be placed in the child's file. Recommendations developed as part of the level of care
4.5determination process shall include specific community services needed by the child and,
4.6if appropriate, the child's family, and shall indicate whether or not these services are
4.7available and accessible to the child and family.
4.8During the level of care determination process, the child, child's family, or child's
4.9legal representative, as appropriate, must be informed of the child's eligibility for case
4.10management services and family community support services and that an individual
4.11family community support plan is being developed by the case manager, if assigned.
4.12The level of care determination shall comply with section 260C.212. Wherever
4.13possible, the parent shall be consulted in the process, unless clinically inappropriate.
4.14The level of care determination, and placement decision, and recommendations for
4.15mental health services must be documented in the child's record.
4.16An alternate review process may be approved by the commissioner if the county
4.17board demonstrates that an alternate review process has been established by the county
4.18board and the times of review, persons responsible for the review, and review criteria are
4.19comparable to the standards in clauses (1) to (4).

4.20    Sec. 4. Minnesota Statutes 2008, section 245.50, subdivision 5, is amended to read:
4.21    Subd. 5. Special contracts; bordering states. (a) An individual who is detained,
4.22committed, or placed on an involuntary basis under chapter 253B may be confined or
4.23treated in a bordering state pursuant to a contract under this section. An individual who is
4.24detained, committed, or placed on an involuntary basis under the civil law of a bordering
4.25state may be confined or treated in Minnesota pursuant to a contract under this section. A
4.26peace or health officer who is acting under the authority of the sending state may transport
4.27an individual to a receiving agency that provides services pursuant to a contract under
4.28this section and may transport the individual back to the sending state under the laws
4.29of the sending state. Court orders valid under the law of the sending state are granted
4.30recognition and reciprocity in the receiving state for individuals covered by a contract
4.31under this section to the extent that the court orders relate to confinement for treatment
4.32or care of mental illness or chemical dependency. Such treatment or care may address
4.33other conditions that may be co-occurring with the mental illness or chemical dependency.
4.34These court orders are not subject to legal challenge in the courts of the receiving state.
4.35Individuals who are detained, committed, or placed under the law of a sending state and
5.1who are transferred to a receiving state under this section continue to be in the legal
5.2custody of the authority responsible for them under the law of the sending state. Except
5.3in emergencies, those individuals may not be transferred, removed, or furloughed from
5.4a receiving agency without the specific approval of the authority responsible for them
5.5under the law of the sending state.
5.6    (b) While in the receiving state pursuant to a contract under this section, an
5.7individual shall be subject to the sending state's laws and rules relating to length of
5.8confinement, reexaminations, and extensions of confinement. No individual may be sent
5.9to another state pursuant to a contract under this section until the receiving state has
5.10enacted a law recognizing the validity and applicability of this section.
5.11    (c) If an individual receiving services pursuant to a contract under this section leaves
5.12the receiving agency without permission and the individual is subject to involuntary
5.13confinement under the law of the sending state, the receiving agency shall use all
5.14reasonable means to return the individual to the receiving agency. The receiving agency
5.15shall immediately report the absence to the sending agency. The receiving state has the
5.16primary responsibility for, and the authority to direct, the return of these individuals
5.17within its borders and is liable for the cost of the action to the extent that it would be
5.18liable for costs of its own resident.
5.19    (d) Responsibility for payment for the cost of care remains with the sending agency.
5.20    (e) This subdivision also applies to county contracts under subdivision 2 which
5.21include emergency care and treatment provided to a county resident in a bordering state.
5.22    (f) If a Minnesota resident is admitted to a facility in a bordering state under this
5.23chapter, a physician, licensed psychologist who has a doctoral degree in psychology, or
5.24an advance practice registered nurse certified in mental health, who is licensed in the
5.25bordering state, may act as an examiner under sections 253B.07, 253B.08, 253B.092,
5.26253B.12 , and 253B.17 subject to the same requirements and limitations in section
5.27253B.02, subdivision 7 . The examiner may initiate an emergency hold under section
5.28253B.05 on a Minnesota resident who is in a hospital under contract with a Minnesota
5.29governmental entity under this section providing the patient, in the professional opinion of
5.30the examiner, meets the criteria in section 253B.05.

5.31    Sec. 5. Minnesota Statutes 2008, section 256B.0615, subdivision 1, is amended to read:
5.32    Subdivision 1. Scope. Medical assistance covers mental health certified peers
5.33specialists services, as established in subdivision 2, subject to federal approval, if provided
5.34to recipients who are eligible for services under sections 256B.0622 and, 256B.0623, and
6.1256B.0624 and are provided by a certified peer specialist who has completed the training
6.2under subdivision 5.

6.3    Sec. 6. Minnesota Statutes 2008, section 256B.0615, subdivision 3, is amended to read:
6.4    Subd. 3. Eligibility. Peer support services may be made available to consumers
6.5of (1) the intensive rehabilitative mental health services under section 256B.0622; and
6.6(2) adult rehabilitative mental health services under section 256B.0623; and (3) crisis
6.7stabilization services under section 256B.0624.

6.8    Sec. 7. Minnesota Statutes 2008, section 256B.0622, subdivision 8, is amended to read:
6.9    Subd. 8. Medical assistance payment for intensive rehabilitative mental health
6.10services. (a) Payment for residential and nonresidential services in this section shall be
6.11based on one daily rate per provider inclusive of the following services received by an
6.12eligible recipient in a given calendar day: all rehabilitative services under this section,
6.13staff travel time to provide rehabilitative services under this section, and nonresidential
6.14crisis stabilization services under section 256B.0624.
6.15(b) Except as indicated in paragraph (c), payment will not be made to more than one
6.16entity for each recipient for services provided under this section on a given day. If services
6.17under this section are provided by a team that includes staff from more than one entity, the
6.18team must determine how to distribute the payment among the members.
6.19(c) The host county shall recommend to the commissioner one rate for each entity
6.20that will bill medical assistance for residential services under this section and two rates
6.21one rate for each nonresidential provider. The first nonresidential rate is for recipients who
6.22are not receiving residential services. The second nonresidential rate is for recipients
6.23who are temporarily receiving residential services and need continued contact with the
6.24nonresidential team to assure timely discharge from residential services. In developing
6.25these rates, the host county shall consider and document:
6.26(1) the cost for similar services in the local trade area;
6.27(2) actual costs incurred by entities providing the services;
6.28(3) the intensity and frequency of services to be provided to each recipient, including
6.29the proposed overall number of units of service to be delivered;
6.30(4) the degree to which recipients will receive services other than services under
6.31this section;
6.32(5) the costs of other services that will be separately reimbursed; and
6.33(6) input from the local planning process authorized by the adult mental health
6.34initiative under section 245.4661, regarding recipients' service needs.
7.1(d) The rate for intensive rehabilitative mental health services must exclude room
7.2and board, as defined in section 256I.03, subdivision 6, and services not covered under
7.3this section, such as partial hospitalization, home care, and inpatient services. Physician
7.4services that are not separately billed may be included in the rate to the extent that a
7.5psychiatrist is a member of the treatment team. The county's recommendation shall
7.6specify the period for which the rate will be applicable, not to exceed two years.
7.7(e) When services under this section are provided by an assertive community team,
7.8case management functions must be an integral part of the team.
7.9(f) The rate for a provider must not exceed the rate charged by that provider for
7.10the same service to other payors.
7.11(g) The commissioner shall approve or reject the county's rate recommendation,
7.12based on the commissioner's own analysis of the criteria in paragraph (c).

7.13    Sec. 8. Minnesota Statutes 2008, section 256B.0623, subdivision 5, is amended to read:
7.14    Subd. 5. Qualifications of provider staff. Adult rehabilitative mental health
7.15services must be provided by qualified individual provider staff of a certified provider
7.16entity. Individual provider staff must be qualified under one of the following criteria:
7.17    (1) a mental health professional as defined in section 245.462, subdivision 18,
7.18clauses (1) to (5). If the recipient has a current diagnostic assessment by a licensed
7.19mental health professional as defined in section 245.462, subdivision 18, clauses (1) to
7.20(5), recommending receipt of adult mental health rehabilitative services, the definition of
7.21mental health professional for purposes of this section includes a person who is qualified
7.22under section 245.462, subdivision 18, clause (6), and who holds a current and valid
7.23national certification as a certified rehabilitation counselor or certified psychosocial
7.24rehabilitation practitioner;
7.25    (2) a mental health practitioner as defined in section 245.462, subdivision 17. The
7.26mental health practitioner must work under the clinical supervision of a mental health
7.27professional;
7.28    (3) a certified peer specialist under section 256B.0615. The certified peer specialist
7.29must work under the clinical supervision of a mental health professional; or
7.30    (4) a mental health rehabilitation worker. A mental health rehabilitation worker
7.31means a staff person working under the direction of a mental health practitioner or mental
7.32health professional and under the clinical supervision of a mental health professional in
7.33the implementation of rehabilitative mental health services as identified in the recipient's
7.34individual treatment plan who:
7.35    (i) is at least 21 years of age;
8.1    (ii) has a high school diploma or equivalent;
8.2    (iii) has successfully completed 30 hours of training during the past two years
8.3immediately prior to the date of hire, or before provision of direct services, in all of
8.4the following areas: recipient rights, recipient-centered individual treatment planning,
8.5behavioral terminology, mental illness, co-occurring mental illness and substance abuse,
8.6psychotropic medications and side effects, functional assessment, local community
8.7resources, adult vulnerability, recipient confidentiality; and
8.8    (iv) meets the qualifications in subitem (A) or (B):
8.9    (A) has an associate of arts degree or two years full-time postsecondary education
8.10in one of the behavioral sciences or human services, or; is a registered nurse without a
8.11bachelor's degree,; or who within the previous ten years has:
8.12    (1) three years of personal life experience with serious and persistent mental illness;
8.13    (2) three years of life experience as a primary caregiver to an adult with a serious
8.14mental illness or traumatic brain injury; or
8.15    (3) 4,000 hours of supervised paid work experience in the delivery of mental health
8.16services to adults with a serious mental illness or traumatic brain injury; or
8.17    (B)(1) is fluent in the non-English language or competent in the culture of the
8.18ethnic group to which at least 20 percent of the mental health rehabilitation worker's
8.19clients belong;
8.20    (2) receives during the first 2,000 hours of work, monthly documented individual
8.21clinical supervision by a mental health professional;
8.22    (3) has 18 hours of documented field supervision by a mental health professional
8.23or practitioner during the first 160 hours of contact work with recipients, and at least six
8.24hours of field supervision quarterly during the following year;
8.25    (4) has review and cosignature of charting of recipient contacts during field
8.26supervision by a mental health professional or practitioner; and
8.27    (5) has 40 15 hours of additional continuing education on mental health topics during
8.28the first year of employment and 15 hours during every additional year of employment.

8.29    Sec. 9. Minnesota Statutes 2008, section 256B.0624, subdivision 8, is amended to read:
8.30    Subd. 8. Adult crisis stabilization staff qualifications. (a) Adult mental health
8.31crisis stabilization services must be provided by qualified individual staff of a qualified
8.32provider entity. Individual provider staff must have the following qualifications:
8.33(1) be a mental health professional as defined in section 245.462, subdivision 18,
8.34clauses (1) to (5);
9.1(2) be a mental health practitioner as defined in section 245.462, subdivision 17.
9.2The mental health practitioner must work under the clinical supervision of a mental health
9.3professional; or
9.4(3) be a certified peer specialist under section 256B.0615. The certified peer
9.5specialist must work under the clinical supervision of a mental health professional; or
9.6(4) be a mental health rehabilitation worker who meets the criteria in section
9.7256B.0623, subdivision 5 , clause (3) (4); works under the direction of a mental health
9.8practitioner as defined in section 245.462, subdivision 17, or under direction of a
9.9mental health professional; and works under the clinical supervision of a mental health
9.10professional.
9.11(b) Mental health practitioners and mental health rehabilitation workers must have
9.12completed at least 30 hours of training in crisis intervention and stabilization during
9.13the past two years.

9.14    Sec. 10. Minnesota Statutes 2008, section 256B.0625, subdivision 49, is amended to
9.15read:
9.16    Subd. 49. Community health worker. (a) Medical assistance covers the care
9.17coordination and patient education services provided by a community health worker if
9.18the community health worker has:
9.19    (1) received a certificate from the Minnesota State Colleges and Universities System
9.20approved community health worker curriculum; or
9.21    (2) at least five years of supervised experience with an enrolled physician, registered
9.22nurse, advanced practice registered nurse, mental health professional as defined in section
9.23245.462, subdivision 18, clauses (1) to (5), and section 245.4871, subdivision 27, clauses
9.24(1) to (5), or dentist, or at least five years of supervised experience by a certified public
9.25health nurse operating under the direct authority of an enrolled unit of government.
9.26Community health workers eligible for payment under clause (2) must complete the
9.27certification program by January 1, 2010, to continue to be eligible for payment.
9.28    (b) Community health workers must work under the supervision of a medical
9.29assistance enrolled physician, registered nurse, advanced practice registered nurse,
9.30mental health professional as defined in section 245.462, subdivision 18, clauses (1) to
9.31(5), and section 245.4871, subdivision 27, clauses (1) to (5), or dentist, or work under
9.32the supervision of a certified public health nurse operating under the direct authority of
9.33an enrolled unit of government.
9.34    (c) Care coordination and patient education services covered under this subdivision
9.35include, but are not limited to, services relating to oral health and dental care.

10.1    Sec. 11. Minnesota Statutes 2008, section 256B.0943, subdivision 1, is amended to
10.2read:
10.3    Subdivision 1. Definitions. For purposes of this section, the following terms have
10.4the meanings given them.
10.5(a) "Children's therapeutic services and supports" means the flexible package of
10.6mental health services for children who require varying therapeutic and rehabilitative
10.7levels of intervention. The services are time-limited interventions that are delivered using
10.8various treatment modalities and combinations of services designed to reach treatment
10.9outcomes identified in the individual treatment plan.
10.10(b) "Clinical supervision" means the overall responsibility of the mental health
10.11professional for the control and direction of individualized treatment planning, service
10.12delivery, and treatment review for each client. A mental health professional who is an
10.13enrolled Minnesota health care program provider accepts full professional responsibility
10.14for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
10.15and oversees or directs the supervisee's work.
10.16(c) "County board" means the county board of commissioners or board established
10.17under sections 402.01 to 402.10 or 471.59.
10.18(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.
10.19(e) "Culturally competent provider" means a provider who understands and can
10.20utilize to a client's benefit the client's culture when providing services to the client. A
10.21provider may be culturally competent because the provider is of the same cultural or
10.22ethnic group as the client or the provider has developed the knowledge and skills through
10.23training and experience to provide services to culturally diverse clients.
10.24(f) "Day treatment program" for children means a site-based structured program
10.25consisting of group psychotherapy for more than three individuals and other intensive
10.26therapeutic services provided by a multidisciplinary team, under the clinical supervision
10.27of a mental health professional.
10.28(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
10.2911 .
10.30(h) "Direct service time" means the time that a mental health professional, mental
10.31health practitioner, or mental health behavioral aide spends face-to-face with a client
10.32and the client's family. Direct service time includes time in which the provider obtains
10.33a client's history or provides service components of children's therapeutic services and
10.34supports. Direct service time does not include time doing work before and after providing
10.35direct services, including scheduling, maintaining clinical records, consulting with others
10.36about the client's mental health status, preparing reports, receiving clinical supervision
11.1directly related to the client's psychotherapy session, and revising the client's individual
11.2treatment plan.
11.3(i) "Direction of mental health behavioral aide" means the activities of a mental
11.4health professional or mental health practitioner in guiding the mental health behavioral
11.5aide in providing services to a client. The direction of a mental health behavioral aide
11.6must be based on the client's individualized treatment plan and meet the requirements in
11.7subdivision 6, paragraph (b), clause (5).
11.8(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
11.915 . For persons at least age 18 but under age 21, mental illness has the meaning given in
11.10section 245.462, subdivision 20, paragraph (a).
11.11(k) "Individual behavioral plan" means a plan of intervention, treatment, and
11.12services for a child written by a mental health professional or mental health practitioner,
11.13under the clinical supervision of a mental health professional, to guide the work of the
11.14mental health behavioral aide.
11.15(l) "Individual treatment plan" has the meaning given in section 245.4871,
11.16subdivision 21 .
11.17(m) "Mental health behavioral aide services" means medically necessary one-on-one
11.18activities performed by a trained paraprofessional to assist a child retain or generalize
11.19psychosocial skills as taught by a mental health professional or mental health practitioner
11.20and as described in the child's individual treatment plan and individual behavior plan.
11.21Activities involve working directly with the child or child's family as provided in
11.22subdivision 9, paragraph (b), clause (4).
11.23(m) (n) "Mental health professional" means an individual as defined in section
11.24245.4871, subdivision 27 , clauses (1) to (5), or tribal vendor as defined in section 256B.02,
11.25subdivision 7 , paragraph (b).
11.26(n) (o) "Preschool program" means a day program licensed under Minnesota Rules,
11.27parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
11.28supports provider to provide a structured treatment program to a child who is at least 33
11.29months old but who has not yet attended the first day of kindergarten.
11.30(o) (p) "Skills training" means individual, family, or group training, delivered by
11.31or under the direction of a mental health professional, designed to improve the basic
11.32functioning of the child with emotional disturbance and the child's family in the activities
11.33of daily living and community living, and to improve the social functioning of the child
11.34and the child's family in areas important to the child's maintaining or reestablishing
11.35residency in the community. Individual, family, and group skills training must:
12.1(1) consist of activities designed to promote skill development of the child and the
12.2child's family in the use of age-appropriate daily living skills, interpersonal and family
12.3relationships, and leisure and recreational services;
12.4(2) consist of activities that will assist the family's understanding of normal child
12.5development and to use parenting skills that will help the child with emotional disturbance
12.6achieve the goals outlined in the child's individual treatment plan; and
12.7(3) promote family preservation and unification, promote the family's integration
12.8with the community, and reduce the use of unnecessary out-of-home placement or
12.9institutionalization of children with emotional disturbance. facilitate the acquisition
12.10of psychosocial skills that are medically necessary to rehabilitate the child to an
12.11age-appropriate developmental trajectory heretofore disrupted by a psychiatric illness
12.12or to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
12.13maladaptive skills acquired over the course of a psychiatric illness. Skills training is
12.14subject to the following requirements:
12.15(1) a mental health professional or a mental health practitioner must provide skills
12.16training;
12.17(2) the child must always be present during skills training; however, a brief absence
12.18of the child for no more than ten percent of the session unit may be allowed to redirect or
12.19instruct family members;
12.20(3) skills training delivered to children or their families must be targeted to the
12.21specific deficits or maladaptations of the child's mental health disorder and must be
12.22prescribed in the child's individual treatment plan;
12.23(4) skills training delivered to the child's family must teach skills needed by parents
12.24to enhance the child's skill development and to help the child use in daily life the skills
12.25previously taught by a mental health professional or mental health practitioner and to
12.26develop or maintain a home environment that supports the child's progressive use skills;
12.27(5) group skills training may be provided to multiple recipients who, because of the
12.28nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
12.29interaction in a group setting, which must be staffed as follows:
12.30(i) one mental health professional or one mental health practitioner under supervision
12.31of a licensed mental health professional must work with a group of four to eight clients; or
12.32(ii) two mental health professionals or two mental health practitioners under
12.33supervision of a licensed mental health professional, or one professional plus one
12.34practitioner must work with a group of nine to 12 clients.

13.1    Sec. 12. Minnesota Statutes 2008, section 256B.0943, subdivision 2, is amended to
13.2read:
13.3    Subd. 2. Covered service components of children's therapeutic services and
13.4supports. (a) Subject to federal approval, medical assistance covers medically necessary
13.5children's therapeutic services and supports as defined in this section that an eligible
13.6provider entity certified under subdivisions subdivision 4 and 5 provides to a client
13.7eligible under subdivision 3.
13.8(b) The service components of children's therapeutic services and supports are:
13.9(1) individual, family, and group psychotherapy;
13.10(2) individual, family, or group skills training provided by a mental health
13.11professional or mental health practitioner;
13.12(3) crisis assistance;
13.13(4) mental health behavioral aide services; and
13.14(5) direction of a mental health behavioral aide.
13.15(c) Service components in paragraph (b) may be combined to constitute therapeutic
13.16programs, including day treatment programs and therapeutic preschool programs.
13.17Although day treatment and preschool programs have specific client and provider
13.18eligibility requirements, medical assistance only pays for the service components listed in
13.19paragraph (b).

13.20    Sec. 13. Minnesota Statutes 2008, section 256B.0943, subdivision 4, is amended to
13.21read:
13.22    Subd. 4. Provider entity certification. (a) Effective July 1, 2003, the commissioner
13.23shall establish an initial provider entity application and certification process and
13.24recertification process to determine whether a provider entity has an administrative
13.25and clinical infrastructure that meets the requirements in subdivisions 5 and 6. The
13.26commissioner shall recertify a provider entity at least every three years. The commissioner
13.27shall establish a process for decertification of a provider entity that no longer meets the
13.28requirements in this section. The county, tribe, and the commissioner shall be mutually
13.29responsible and accountable for the county's, tribe's, and state's part of the certification,
13.30recertification, and decertification processes.
13.31(b) For purposes of this section, a provider entity must be:
13.32(1) an Indian health services facility or a facility owned and operated by a tribe or
13.33tribal organization operating as a 638 facility under Public Law 93-638 certified by the
13.34state;
13.35(2) a county-operated entity certified by the state; or
14.1(3) a noncounty entity recommended for certification by the provider's host county
14.2and certified by the state.

14.3    Sec. 14. Minnesota Statutes 2008, section 256B.0943, subdivision 5, is amended to
14.4read:
14.5    Subd. 5. Provider entity administrative infrastructure requirements. (a) To be
14.6an eligible provider entity under this section, a provider entity must have an administrative
14.7infrastructure that establishes authority and accountability for decision making and
14.8oversight of functions, including finance, personnel, system management, clinical practice,
14.9and performance measurement. The provider must have written policies and procedures
14.10that it reviews and updates every three years and distributes to staff initially and upon
14.11each subsequent update.
14.12(b) The administrative infrastructure written policies and procedures must include:
14.13(1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
14.14retention of culturally and linguistically competent providers; (ii) conducting a criminal
14.15background check on all direct service providers and volunteers; (iii) investigating,
14.16reporting, and acting on violations of ethical conduct standards; (iv) investigating,
14.17reporting, and acting on violations of data privacy policies that are compliant with
14.18federal and state laws; (v) utilizing volunteers, including screening applicants, training
14.19and supervising volunteers, and providing liability coverage for volunteers; and (vi)
14.20documenting that each mental health professional, mental health practitioner, or mental
14.21health behavioral aide meets the applicable provider qualification criteria, training criteria
14.22under subdivision 8, and clinical supervision or direction of a mental health behavioral
14.23aide requirements under subdivision 6;
14.24(2) fiscal procedures, including internal fiscal control practices and a process for
14.25collecting revenue that is compliant with federal and state laws;
14.26(3) if a client is receiving services from a case manager or other provider entity, a
14.27service coordination process that ensures services are provided in the most appropriate
14.28manner to achieve maximum benefit to the client. The provider entity must ensure
14.29coordination and nonduplication of services consistent with county board coordination
14.30procedures established under section 245.4881, subdivision 5;
14.31(4) (3) a performance measurement system, including monitoring to determine
14.32cultural appropriateness of services identified in the individual treatment plan, as
14.33determined by the client's culture, beliefs, values, and language, and family-driven
14.34services; and
15.1(5) (4) a process to establish and maintain individual client records. The client's
15.2records must include:
15.3(i) the client's personal information;
15.4(ii) forms applicable to data privacy;
15.5(iii) the client's diagnostic assessment, updates, results of tests, individual treatment
15.6plan, and individual behavior plan, if necessary;
15.7(iv) documentation of service delivery as specified under subdivision 6;
15.8(v) telephone contacts;
15.9(vi) discharge plan; and
15.10(vii) if applicable, insurance information.
15.11(c) A provider entity that uses a restrictive procedure with a client must meet the
15.12requirements of section 245.8261.

15.13    Sec. 15. Minnesota Statutes 2008, section 256B.0943, subdivision 6, is amended to
15.14read:
15.15    Subd. 6. Provider entity clinical infrastructure requirements. (a) To be
15.16an eligible provider entity under this section, a provider entity must have a clinical
15.17infrastructure that utilizes diagnostic assessment, an individualized treatment plan plans,
15.18service delivery, and individual treatment plan review that are culturally competent,
15.19child-centered, and family-driven to achieve maximum benefit for the client. The provider
15.20entity must review, and update as necessary, the clinical policies and procedures every
15.21three years and must distribute the policies and procedures to staff initially and upon
15.22each subsequent update.
15.23    (b) The clinical infrastructure written policies and procedures must include policies
15.24and procedures for:
15.25    (1) providing or obtaining a client's diagnostic assessment that identifies acute and
15.26chronic clinical disorders, co-occurring medical conditions, sources of psychological
15.27and environmental problems, and including a functional assessment. The functional
15.28assessment must clearly summarize the client's individual strengths and needs;
15.29    (2) developing an individual treatment plan that is:
15.30    (i) is based on the information in the client's diagnostic assessment;
15.31(ii) identified goals and objectives of treatment, treatment strategy, schedule for
15.32accomplishing treatment goals and objectives, and the individuals responsible for
15.33providing treatment services and supports;
15.34    (ii) (iii) is developed no later than the end of the first psychotherapy session after the
15.35after completion of the client's diagnostic assessment by the a mental health professional
16.1who provides the client's psychotherapy and before the provision of children's therapeutic
16.2services and supports;
16.3    (iii) (iv) is developed through a child-centered, family-driven, culturally appropriate
16.4 planning process that identifies service needs and individualized, planned, and culturally
16.5appropriate interventions that contain specific treatment goals and objectives for the client
16.6and the client's family or foster family;
16.7    (iv) (v) is reviewed at least once every 90 days and revised, if necessary; and
16.8    (v) (vi) is signed by the clinical supervisor and by the client or, if appropriate, by the
16.9client's parent or other person authorized by statute to consent to mental health services
16.10for the client;
16.11    (3) developing an individual behavior plan that documents services treatment
16.12strategies to be provided by the mental health behavioral aide. The individual behavior
16.13plan must include:
16.14    (i) detailed instructions on the service treatment strategies to be provided;
16.15    (ii) time allocated to each service treatment strategy;
16.16    (iii) methods of documenting the child's behavior;
16.17    (iv) methods of monitoring the child's progress in reaching objectives; and
16.18    (v) goals to increase or decrease targeted behavior as identified in the individual
16.19treatment plan;
16.20    (4) providing clinical supervision of the mental health practitioner and mental health
16.21behavioral aide. A mental health professional must document the clinical supervision
16.22the professional provides by cosigning individual treatment plans and making entries in
16.23the client's record on supervisory activities. Clinical supervision does not include the
16.24authority to make or terminate court-ordered placements of the child. A clinical supervisor
16.25must be available for urgent consultation as required by the individual client's needs or
16.26the situation. Clinical supervision may occur individually or in a small group to discuss
16.27treatment and review progress toward goals. The focus of clinical supervision must be the
16.28client's treatment needs and progress and the mental health practitioner's or behavioral
16.29aide's ability to provide services;
16.30    (4a) CTSS certified provider entities providing meeting day treatment and
16.31therapeutic preschool programs must meet the conditions in items (i) to (iii):
16.32    (i) the supervisor must be present and available on the premises more than 50
16.33percent of the time in a five-working-day period during which the supervisee is providing
16.34a mental health service;
17.1    (ii) the diagnosis and the client's individual treatment plan or a change in the
17.2diagnosis or individual treatment plan must be made by or reviewed, approved, and signed
17.3by the supervisor; and
17.4    (iii) every 30 days, the supervisor must review and sign the record of indicating the
17.5supervisor has reviewed the client's care for all activities in the preceding 30-day period;
17.6    (4b) meeting the clinical supervision standards in items (i) to (iii) for all other
17.7services provided under CTSS, clinical supervision standards provided in items (i) to
17.8(iii) must be used:
17.9    (i) medical assistance shall reimburse for services provided by a mental health
17.10practitioner who maintains a consulting relationship with a mental health professional who
17.11accepts full professional responsibility and is present on site for at least one observation
17.12during the first 12 hours in which the mental health practitioner provides the individual,
17.13family, or group skills training to the child or the child's family;
17.14(ii) medical assistance shall reimburse for services provided by a mental health
17.15behavioral aide who maintains a consulting relationship with a mental health professional
17.16who accepts full professional responsibility and has an approved plan for clinical
17.17supervision of the behavioral aide. Plans will be approved in accordance with supervision
17.18standards promulgated by the commissioner of human services;
17.19    (ii) thereafter, (iii) the mental health professional is required to be present on site
17.20for observation as clinically appropriate when the mental health practitioner or mental
17.21health behavioral aide is providing individual, family, or group skills training to the child
17.22or the child's family CTSS services; and
17.23    (iii) (iv) when conducted, the observation must be a minimum of one clinical
17.24unit. The on-site presence of the mental health professional must be documented in the
17.25child's record and signed by the mental health professional who accepts full professional
17.26responsibility;
17.27    (5) providing direction to a mental health behavioral aide. For entities that employ
17.28mental health behavioral aides, the clinical supervisor must be employed by the provider
17.29entity or other certified children's therapeutic supports and services provider entity to
17.30ensure necessary and appropriate oversight for the client's treatment and continuity
17.31of care. The mental health professional or mental health practitioner giving direction
17.32must begin with the goals on the individualized treatment plan, and instruct the mental
17.33health behavioral aide on how to construct therapeutic activities and interventions that
17.34will lead to goal attainment. The professional or practitioner giving direction must also
17.35instruct the mental health behavioral aide about the client's diagnosis, functional status,
17.36and other characteristics that are likely to affect service delivery. Direction must also
18.1include determining that the mental health behavioral aide has the skills to interact with
18.2the client and the client's family in ways that convey personal and cultural respect and
18.3that the aide actively solicits information relevant to treatment from the family. The aide
18.4must be able to clearly explain the activities the aide is doing with the client and the
18.5activities' relationship to treatment goals. Direction is more didactic than is supervision
18.6and requires the professional or practitioner providing it to continuously evaluate the
18.7mental health behavioral aide's ability to carry out the activities of the individualized
18.8treatment plan and the individualized behavior plan. When providing direction, the
18.9professional or practitioner must:
18.10    (i) review progress notes prepared by the mental health behavioral aide for accuracy
18.11and consistency with diagnostic assessment, treatment plan, and behavior goals and the
18.12professional or practitioner must approve and sign the progress notes;
18.13    (ii) identify changes in treatment strategies, revise the individual behavior plan,
18.14and communicate treatment instructions and methodologies as appropriate to ensure
18.15that treatment is implemented correctly;
18.16    (iii) demonstrate family-friendly behaviors that support healthy collaboration among
18.17the child, the child's family, and providers as treatment is planned and implemented;
18.18    (iv) ensure that the mental health behavioral aide is able to effectively communicate
18.19with the child, the child's family, and the provider; and
18.20    (v) record the results of any evaluation and corrective actions taken to modify the
18.21work of the mental health behavioral aide;
18.22    (6) providing service delivery that implements the individual treatment plan and
18.23meets the requirements under subdivision 9; and
18.24    (7) individual treatment plan review. The review must determine the extent to which
18.25the services have met the goals and objectives in the previous treatment plan. The review
18.26must assess the client's progress and ensure that services and treatment goals continue to
18.27be necessary and appropriate to the client and the client's family or foster family. Revision
18.28of the individual treatment plan does not require a new diagnostic assessment unless the
18.29client's mental health status has changed markedly. The updated treatment plan must be
18.30signed by the clinical supervisor and by the client, if appropriate, and by the client's
18.31parent or other person authorized by statute to give consent to the mental health services
18.32for the child.

18.33    Sec. 16. Minnesota Statutes 2008, section 256B.0943, subdivision 7, is amended to
18.34read:
19.1    Subd. 7. Qualifications of individual and team providers. (a) An individual
19.2or team provider working within the scope of the provider's practice or qualifications
19.3may provide service components of children's therapeutic services and supports that are
19.4identified as medically necessary in a client's individual treatment plan.
19.5(b) An individual provider must be qualified as:
19.6(1) a mental health professional as defined in subdivision 1, paragraph (m); or
19.7(2) a mental health practitioner as defined in section 245.4871, subdivision 26. The
19.8mental health practitioner must work under the clinical supervision of a mental health
19.9professional; or
19.10(3) a mental health behavioral aide working under the direction clinical supervision
19.11of a mental health professional to implement the rehabilitative mental health services
19.12identified in the client's individual treatment plan and individual behavior plan.
19.13(A) A level I mental health behavioral aide must:
19.14(i) be at least 18 years old;
19.15(ii) have a high school diploma or general equivalency diploma (GED) or two years
19.16of experience as a primary caregiver to a child with severe emotional disturbance within
19.17the previous ten years; and
19.18(iii) meet preservice and continuing education requirements under subdivision 8.
19.19(B) A level II mental health behavioral aide must:
19.20(i) be at least 18 years old;
19.21(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
19.22clinical services in the treatment of mental illness concerning children or adolescents.
19.23Hours worked as a mental health behavioral aide I may be included in the 4,000 hours
19.24of experience; and
19.25(iii) meet preservice and continuing education requirements in subdivision 8.
19.26(c) A preschool program multidisciplinary team must include at least one mental
19.27health professional and one or more of the following individuals under the clinical
19.28supervision of a mental health professional:
19.29(i) a mental health practitioner; or
19.30(ii) a program person, including a teacher, assistant teacher, or aide, who meets the
19.31qualifications and training standards of a level I mental health behavioral aide.
19.32(d) A day treatment multidisciplinary team must include at least one mental health
19.33professional and one mental health practitioner.

19.34    Sec. 17. Minnesota Statutes 2008, section 256B.0943, subdivision 9, is amended to
19.35read:
20.1    Subd. 9. Service delivery criteria. (a) In delivering services under this section, a
20.2certified provider entity must ensure that:
20.3    (1) each individual provider's caseload size permits the provider to deliver services
20.4to both clients with severe, complex needs and clients with less intensive needs. The
20.5provider's caseload size should reasonably enable the provider to play an active role in
20.6service planning, monitoring, and delivering services to meet the client's and client's
20.7family's needs, as specified in each client's individual treatment plan;
20.8    (2) site-based programs, including day treatment and preschool programs, provide
20.9staffing and facilities to ensure the client's health, safety, and protection of rights, and that
20.10the programs are able to implement each client's individual treatment plan;
20.11    (3) a day treatment program is provided to a group of clients by a multidisciplinary
20.12team under the clinical supervision of a mental health professional. The day treatment
20.13program must be provided in and by: (i) an outpatient hospital accredited by the Joint
20.14Commission on Accreditation of Health Organizations and licensed under sections 144.50
20.15to 144.55; (ii) a community mental health center under section 245.62; and or (iii) an
20.16entity that is under contract with the county board to operate a program that meets the
20.17requirements of sections 245.4712, subdivision 2, and or 245.4884, subdivision 2, and
20.18Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must
20.19stabilize the client's mental health status while developing and improving the client's
20.20independent living and socialization skills. The goal of the day treatment program must
20.21be to reduce or relieve the effects of mental illness and provide training to enable the
20.22client to live in the community. The program must be available at least one day a week
20.23for a three-hour two-hour time block. The three-hour two-hour time block must include
20.24at least one hour, but no more than two hours, of individual or group psychotherapy.
20.25The remainder of the three-hour time block may include recreation therapy, socialization
20.26therapy, or independent living skills therapy, but only if the therapies are included in the
20.27client's individual treatment plan. The remainder of the structured treatment program
20.28may include individual or group psychotherapy and individual or group skills training, if
20.29included in the client's individual treatment plan. Day treatment programs are not part of
20.30inpatient or residential treatment services. A day treatment program may provide fewer
20.31than the minimally required hours for a particular child during a billing period in which
20.32the child is transitioning into, or out of, the program; and
20.33    (4) a therapeutic preschool program is a structured treatment program offered
20.34to a child who is at least 33 months old, but who has not yet reached the first day of
20.35kindergarten, by a preschool multidisciplinary team in a day program licensed under
20.36Minnesota Rules, parts 9503.0005 to 9503.0175. The program must be available at
21.1least one day a week for a minimum two-hour time block two hours per day, five days
21.2per week, and 12 months of each calendar year. The structured treatment program may
21.3include individual or group psychotherapy and recreation therapy, socialization therapy,
21.4or independent living skills therapy individual or group skills training, if included in the
21.5client's individual treatment plan. A therapeutic preschool program may provide fewer
21.6than the minimally required hours for a particular child during a billing period in which
21.7the child is transitioning into, or out of, the program.
21.8    (b) A provider entity must deliver the service components of children's therapeutic
21.9services and supports in compliance with the following requirements:
21.10    (1) individual, family, and group psychotherapy must be delivered as specified in
21.11Minnesota Rules, part 9505.0323;
21.12    (2) individual, family, or group skills training must be provided by a mental health
21.13professional or a mental health practitioner who has a consulting relationship with a
21.14mental health professional who accepts full professional responsibility for the training;
21.15    (3) crisis assistance must be time-limited and designed to resolve or stabilize crisis
21.16through arrangements for direct intervention and support services to the child and the
21.17child's family. Crisis assistance must utilize resources designed to address abrupt or
21.18substantial changes in the functioning of the child or the child's family as evidenced by
21.19a sudden change in behavior with negative consequences for well being, a loss of usual
21.20coping mechanisms, or the presentation of danger to self or others;
21.21    (4) mental health behavioral aide services must be medically necessary services that
21.22are provided by a mental health behavioral aide must be treatment services, identified in
21.23the child's individual treatment plan and individual behavior plan, which are performed
21.24minimally by a paraprofessional qualified according to subdivision 7, paragraph (b),
21.25clause (3), and which are designed to improve the functioning of the child and support
21.26the family in activities of daily and community living. in the progressive use of
21.27developmentally appropriate psychosocial skills. Activities involve working directly with
21.28the child, child-peer groupings, or child-family groupings to practice, repeat, reintroduce,
21.29and master the skills defined in subdivision 1, paragraph (p), as previously taught by a
21.30mental health professional or mental health practitioner including:
21.31(i) providing cues or prompts in skill-building peer-to-peer or parent-child
21.32interactions so that the child progressively recognizes and responds to the cues
21.33independently;
21.34(ii) performing as a practice partner or role-play partner;
21.35(iii) reinforcing the child's accomplishments;
21.36(iv) generalizing skill-building activities in the child's multiple natural settings;
22.1(v) assigning further practice activities; and
22.2(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
22.3behavior that puts the child or other person at risk of injury.
22.4A mental health behavioral aide must document the delivery of services in written progress
22.5notes. The mental health behavioral aide must implement goals in the treatment plan for
22.6the child's emotional disturbance that allow the child to acquire developmentally and
22.7therapeutically appropriate daily living skills, social skills, and leisure and recreational
22.8skills through targeted activities. These activities may include:
22.9    (i) assisting a child as needed with skills development in dressing, eating, and
22.10toileting;
22.11    (ii) assisting, monitoring, and guiding the child to complete tasks, including
22.12facilitating the child's participation in medical appointments;
22.13    (iii) observing the child and intervening to redirect the child's inappropriate behavior;
22.14    (iv) assisting the child in using age-appropriate self-management skills as related
22.15to the child's emotional disorder or mental illness, including problem solving, decision
22.16making, communication, conflict resolution, anger management, social skills, and
22.17recreational skills;
22.18    (v) implementing deescalation techniques as recommended by the mental health
22.19professional;
22.20    (vi) implementing any other mental health service that the mental health professional
22.21has approved as being within the scope of the behavioral aide's duties; or
22.22    (vii) assisting the parents to develop and use parenting skills that help the child
22.23achieve the goals outlined in the child's individual treatment plan or individual behavioral
22.24plan. Parenting skills must be directed exclusively to the child's treatment treatment
22.25strategies in the individual treatment plan and the individual behavior plan. The mental
22.26health behavioral aide must document the delivery of services in written progress notes.
22.27Progress notes must reflect implementation of the treatment strategies, as performed by
22.28the mental health behavioral aide and the child's responses to the treatment strategies; and
22.29    (5) direction of a mental health behavioral aide must include the following:
22.30    (i) a total of one hour of on-site observation by a mental health professional during
22.31the first 12 hours of service provided to a child;
22.32    (ii) ongoing on-site observation by a mental health professional or mental health
22.33practitioner for at least a total of one hour during every 40 hours of service provided
22.34to a child; and
22.35    (iii) immediate accessibility of the mental health professional or mental health
22.36practitioner to the mental health behavioral aide during service provision.

23.1    Sec. 18. Minnesota Statutes 2008, section 256B.0944, subdivision 5, is amended to
23.2read:
23.3    Subd. 5. Mobile crisis intervention staff qualifications. (a) To provide children's
23.4mental health mobile crisis intervention services, a mobile crisis intervention team must
23.5include:
23.6(1) at least two mental health professionals as defined in section 256B.0943,
23.7subdivision 1 , paragraph (m) (n); or
23.8(2) a combination of at least one mental health professional and one mental health
23.9practitioner as defined in section 245.4871, subdivision 26, with the required mental
23.10health crisis training and under the clinical supervision of a mental health professional on
23.11the team.
23.12(b) The team must have at least two people with at least one member providing
23.13on-site crisis intervention services when needed. Team members must be experienced in
23.14mental health assessment, crisis intervention techniques, and clinical decision making
23.15under emergency conditions and have knowledge of local services and resources. The
23.16team must recommend and coordinate the team's services with appropriate local resources,
23.17including the county social services agency, mental health service providers, and local law
23.18enforcement, if necessary.

23.19    Sec. 19. RATE SETTING.
23.20The commissioner shall implement a new statewide rate setting methodology for
23.21intensive residential and nonresidential mental health services starting January 1, 2010.
23.22The new rate setting methodology shall be fiscally neutral and consistent with federal and
23.23state Medicaid rules, regulations, procedures, and practices.
23.24EFFECTIVE DATE.This section is effective for services provided on or after
23.25January 1, 2010, and does not change contracts or agreements relating to services provided
23.26before January 1, 2010.