SF 1615

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/01/2023 09:08am

A bill for an act
relating to human services; modifying mental health services eligibility and rates;
amending Minnesota Statutes 2022, sections 254B.04, subdivision 1; 256B.0622,
subdivision 8; 256B.0757, subdivision 5; 256B.0941, subdivision 3; 256B.0947,
subdivision 7.

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

Section 1.

Minnesota Statutes 2022, section 254B.04, subdivision 1, is amended to read:

Subdivision 1.

Eligibility.

(a) Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, who meet the income standards of section 256B.056,
subdivision 4, and are not enrolled in medical assistance, are entitled to behavioral health
fund services. State money appropriated for this paragraph must be placed in a separate
account established for this purpose.

(b) Persons with dependent children who are determined to be in need of chemical
dependency treatment pursuant to an assessment under section 260E.20, subdivision 1, or
a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
local agency to access needed treatment services. Treatment services must be appropriate
for the individual or family, which may include long-term care treatment or treatment in a
facility that allows the dependent children to stay in the treatment facility. The county shall
pay for out-of-home placement costs, if applicable.

(c) Notwithstanding paragraph (a), persons enrolled in medical assistance new text begin and
MinnesotaCare new text end are eligible for room and board services under section 254B.05, subdivision
5, paragraph (b), clause (12).

new text begin (d) Persons enrolled in MinnesotaCare are eligible for room and board services when
provided through intensive residential treatment services and residential crisis services under
section 256B.0622.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256B.0622, subdivision 8, is amended to read:

Subd. 8.

Medical assistance payment for assertive community treatment and
intensive residential treatment services.

(a) Payment for intensive residential treatment
services and assertive community treatment in this section shall be based on one daily rate
per provider inclusive of the following services received by an eligible client in a given
calendar day: all rehabilitative services under this section, staff travel time to provide
rehabilitative services under this section, and nonresidential crisis stabilization services
under section 256B.0624.

(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each client for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.

(c) The commissioner shall determine one rate for each provider that will bill medical
assistance for residential services under this section and one rate for each assertive community
treatment provider. If a single entity provides both services, one rate is established for the
entity's residential services and another rate for the entity's nonresidential services under
this section. A provider is not eligible for payment under this section without authorization
from the commissioner. The commissioner shall develop rates using the following criteria:

(1) the provider's cost for services shall include direct services costs, other program
costs, and other costs determined as follows:

(i) the direct services costs must be determined using actual costs of salaries, benefits,
payroll taxes, and training of direct service staff and service-related transportation;

(ii) other program costs not included in item (i) must be determined as a specified
percentage of the direct services costs as determined by item (i). The percentage used shall
be determined by the commissioner based upon the average of percentages that represent
the relationship of other program costs to direct services costs among the entities that provide
similar services;

(iii) physical plant costs calculated based on the percentage of space within the program
that is entirely devoted to treatment and programming. This does not include administrative
or residential space;

(iv) assertive community treatment physical plant costs must be reimbursed as part of
the costs described in item (ii); deleted text begin and
deleted text end

(v) subject to federal approval, up to an additional five percent of the total rate may be
added to the program rate as a quality incentive based upon the entity meeting performance
criteria specified by the commissioner;

new text begin (vi) for assertive community treatment, intensive residential treatment services, and
residential crisis services, providers may include in their prospective cost-based rate-setting
methodology a line item reflecting estimated additional staffing compensation costs.
Estimated additional staffing compensation costs are subject to review by the commissioner;
and
new text end

new text begin (vii) for intensive residential treatment services and residential crisis services, providers
may include in their prospective cost-based rate-setting methodology a line item reflecting
estimated new capital costs. Estimated new capital costs are subject to review by the
commissioner;
new text end

(2) actual cost is defined as costs which are allowable, allocable, and reasonable, and
consistent with federal reimbursement requirements under Code of Federal Regulations,
title 48, chapter 1, part 31, relating to for-profit entities, and Office of Management and
Budget Circular Number A-122, relating to nonprofit entities;

(3) the number of service units;

(4) the degree to which clients will receive services other than services under this section;
and

(5) the costs of other services that will be separately reimbursed.

(d) The rate for intensive residential treatment services and assertive community treatment
must exclude room and board, as defined in section 256I.03, subdivision 6, and services
not covered under this section, such as partial hospitalization, home care, and inpatient
services.

(e) Physician services that are not separately billed may be included in the rate to the
extent that a psychiatrist, or other health care professional providing physician services
within their scope of practice, is a member of the intensive residential treatment services
treatment team. Physician services, whether billed separately or included in the rate, may
be delivered by telehealth. For purposes of this paragraph, "telehealth" has the meaning
given to "mental health telehealth" in section 256B.0625, subdivision 46, when telehealth
is used to provide intensive residential treatment services.

(f) When services under this section are provided by an assertive community treatment
provider, case management functions must be an integral part of the team.

(g) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payors.

(h) The rates for existing programs must be established prospectively based upon the
expenditures and utilization over a prior 12-month period using the criteria established in
paragraph (c). The rates for new programs must be established based upon estimated
expenditures and estimated utilization using the criteria established in paragraph (c).

(i) Entities who discontinue providing services must be subject to a settle-up process
whereby actual costs and reimbursement for the previous 12 months are compared. In the
event that the entity was paid more than the entity's actual costs plus any applicable
performance-related funding due the provider, the excess payment must be reimbursed to
the department. If a provider's revenue is less than actual allowed costs due to lower
utilization than projected, the commissioner may reimburse the provider to recover its actual
allowable costs. The resulting adjustments by the commissioner must be proportional to the
percent of total units of service reimbursed by the commissioner and must reflect a difference
of greater than five percent.

(j) A provider may request of the commissioner a review of any rate-setting decision
made under this subdivision.

Sec. 3.

Minnesota Statutes 2022, section 256B.0757, subdivision 5, is amended to read:

Subd. 5.

Payments.

The commissioner shall deleted text begin make payments to each designated provider
for the provision of deleted text end new text begin implement a single statewide reimbursement rate for behavioral new text end health
home services deleted text begin described in subdivision 3 to each eligible individual under subdivision 2
that selects the health home as a provider deleted text end new text begin under this section. In implementing this rate, the
commissioner must include input from stakeholders, including providers of the services.
The commissioner shall adjust the statewide reimbursement rate annually by the Consumer
Price Index for medical care services. The statewide reimbursement rate must include
estimated staff expenses for salary and benefits reflecting the required behavioral health
home staffing compliment new text end .

Sec. 4.

Minnesota Statutes 2022, section 256B.0941, subdivision 3, is amended to read:

Subd. 3.

Per diem rate.

(a) The commissioner must establish one per diem rate per
provider for psychiatric residential treatment facility services for individuals 21 years of
age or younger. The rate for a provider must not exceed the rate charged by that provider
for the same service to other payers. Payment must not be made to more than one entity for
each individual for services provided under this section on a given day. The commissioner
must set rates prospectively for the annual rate period. The commissioner must require
providers to submit annual cost reports on a uniform cost reporting form and must use
submitted cost reports to inform the rate-setting process. The cost reporting must be done
according to federal requirements for Medicare cost reports. new text begin The commissioner shall establish
a cost-settlement process to coincide with the annual rate-setting process. The cost-settlement
process must review annualized psychiatric residential treatment facility services costs, as
identified by allowable costs outlined in the cost report, and must provide for settlement
where costs exceeded reimbursements from the prior year rate.
new text end

(b) The following are included in the rate:

(1) costs necessary for licensure and accreditation, meeting all staffing standards for
participation, meeting all service standards for participation, meeting all requirements for
active treatment, maintaining medical records, conducting utilization review, meeting
inspection of care, and discharge planning. The direct services costs must be determined
using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff
and service-related transportation; and

(2) payment for room and board provided by facilities meeting all accreditation and
licensing requirements for participation.

(c) A facility may submit a claim for payment outside of the per diem for professional
services arranged by and provided at the facility by an appropriately licensed professional
who is enrolled as a provider with Minnesota health care programs. Arranged services may
be billed by either the facility or the licensed professional. These services must be included
in the individual plan of care and are subject to prior authorization.

(d) Medicaid must reimburse for concurrent services as approved by the commissioner
to support continuity of care and successful discharge from the facility. "Concurrent services"
means services provided by another entity or provider while the individual is admitted to a
psychiatric residential treatment facility. Payment for concurrent services may be limited
and these services are subject to prior authorization by the state's medical review agent.
Concurrent services may include targeted case management, assertive community treatment,
clinical care consultation, team consultation, and treatment planning.

(e) Payment rates under this subdivision must not include the costs of providing the
following services:

(1) educational services;

(2) acute medical care or specialty services for other medical conditions;

(3) dental services; and

(4) pharmacy drug costs.

(f) For purposes of this section, "actual cost" means costs that are allowable, allocable,
reasonable, and consistent with federal reimbursement requirements in Code of Federal
Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of
Management and Budget Circular Number A-122, relating to nonprofit entities.

new text begin (g) The commissioner shall annually adjust psychiatric residential treatment facility
services per diem rates to reflect the change in the federal Centers for Medicare and Medicaid
Services Inpatient Psychiatric Facility Market Basket. The commissioner shall use the
indices as forecasted for the midpoint of the prior rate year to the midpoint of the current
rate year.
new text end

Sec. 5.

Minnesota Statutes 2022, section 256B.0947, subdivision 7, is amended to read:

Subd. 7.

Medical assistance payment and rate setting.

(a) Payment for services in this
section must be based on one daily encounter rate per provider inclusive of the following
services received by an eligible client in a given calendar day: all rehabilitative services,
supports, and ancillary activities under this section, staff travel time to provide rehabilitative
services under this section, and crisis response services under section 256B.0624.

(b) Payment must not be made to more than one entity for each client for services
provided under this section on a given day. If services under this section are provided by a
team that includes staff from more than one entity, the team shall determine how to distribute
the payment among the members.

(c) The commissioner shall establish regional cost-based rates for entities that will bill
medical assistance for nonresidential intensive rehabilitative mental health services. In
developing these rates, the commissioner shall consider:

(1) the cost for similar services in the health care trade area;

(2) actual costs incurred by entities providing the services;

(3) the intensity and frequency of services to be provided to each client;

(4) the degree to which clients will receive services other than services under this section;
deleted text begin and
deleted text end

(5) the costs of other services that will be separately reimbursed deleted text begin . deleted text end new text begin ; and
new text end

new text begin (6) the estimated additional staffing compensation costs for the next rate year as reported
by entities providing the service.
new text end

(d) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers.