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SF 2414

3rd Engrossment - 89th Legislature (2015 - 2016) Posted on 09/28/2016 08:42am

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

Current Version - 3rd Engrossment

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A bill for an act
relating to human services; modifying the office of ombudsman for long-term
care, chemical and mental health treatment services, and miscellaneous policy
provisions; establishing the Minnesota Eligibility System Executive Steering
Committee; amending Minnesota Statutes 2014, sections 62V.11, by adding
a subdivision; 148.975, subdivision 1; 148B.1751; 148F.13, subdivision 2;
245.462, subdivision 18; 245.4871, subdivision 27; 245A.11, subdivision
2a; 256.974; 256.9741, subdivision 5, by adding subdivisions; 256.9742;
256B.0615, subdivisions 1, 2; 256B.0622, as amended; 256B.0751, subdivision
3; 256B.0947, subdivision 2; Minnesota Statutes 2015 Supplement, sections
62V.03, subdivision 2; 125A.08; 256.01, subdivision 12a; 256B.0911,
subdivision 3a; 256B.766; 256I.04, subdivision 2a; 402A.18, subdivision 3;
proposing coding for new law in Minnesota Statutes, chapter 62V.

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

ARTICLE 1

OMBUDSMAN FOR LONG-TERM CARE

Section 1.

Minnesota Statutes 2014, section 256.974, is amended to read:


256.974 OFFICE OF OMBUDSMAN FOR LONG-TERM CAREdeleted text begin; LOCAL
PROGRAMS
deleted text end.

The ombudsman for long-term care serves in the classified service under section
256.01, subdivision 7, in an office within the Minnesota Board on Aging that incorporates
the long-term care ombudsman program required by the Older Americans Act, as
amended, United States Code, title 42, deleted text beginsectiondeleted text endnew text begin sectionsnew text end 3027(a)(9) and 3058g(a), and
deleted text beginestablished within the Minnesota Board on Aging. The Minnesota Board on Aging may
make grants to and designate local programs for the provision of ombudsman services to
clients in county or multicounty areas. The local program
deleted text endnew text begin Code of Federal Regulations,
title 45, parts 1321 and 1327. The office shall be a distinct entity, separately identifiable
from other state agencies and
new text end may not be an agency engaged in the provision of nursing
home care, hospital care, or home care services either directly or by contract, or have the
responsibility for planning, coordinating, funding, or administering nursing home care,
hospital care, or home care services.

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

Minnesota Statutes 2014, section 256.9741, subdivision 5, is amended to read:


Subd. 5.

Office.

"Office" means the deleted text beginoffice of ombudsmandeleted text end new text beginorganizational unitnew text end
established within the Minnesota Board on Aging deleted text beginor local ombudsman programs that the
Board on Aging designates.
deleted text endnew text begin headed by the state long-term care ombudsman.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2014, section 256.9741, is amended by adding a subdivision
to read:


new text begin Subd. 7. new text end

new text begin Representatives of the office. new text end

new text begin "Representatives of the office" means
employees of the office, as well as employees designated as regional ombudsman and
volunteers designated as certified ombudsman volunteers by the state long-term care
ombudsman.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2014, section 256.9741, is amended by adding a subdivision
to read:


new text begin Subd. 8. new text end

new text begin State long-term care ombudsman. new text end

new text begin "State long-term care ombudsman"
or "ombudsman" means the individual serving on a full-time basis and who in the
individual's official capacity, or through representatives of the office, is responsible to
fulfill the functions, responsibilities, and duties set forth in section 256.9742.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

Minnesota Statutes 2014, section 256.9742, is amended to read:


256.9742 DUTIES AND POWERS OF THE OFFICE.

Subdivision 1.

Duties.

The deleted text beginombudsman's programdeleted text endnew text begin officenew text end shall:

(1) gather information and evaluate any act, practice, policy, procedure, or
administrative action of a long-term care facility, acute care facility, home care service
provider, or government agency that may adversely affect the health, safety, welfare, or
rights of any client;

(2) mediate or advocate on behalf of clients;

(3) monitor the development and implementation of federal, state, or local laws,
rules, regulations, and policies affecting the rights and benefits of clients;

(4) comment on and recommend to public and private agencies regarding laws,
rules, regulations, and policies affecting clients;

(5) inform public agencies about the problems of clients;

(6) provide for training of volunteers and promote the development of citizen
participation in the work of the office;

(7) conduct public forums to obtain information about and publicize issues affecting
clients;

(8) provide public education regarding the health, safety, welfare, and rights of
clients; and

(9) collect and analyze data relating to complaints, conditions, and services.

Subd. 1a.

Designationdeleted text begin; local ombudsman staff and volunteersdeleted text endnew text begin of representatives
of the office
new text end.

(a) In designating deleted text beginan individualdeleted text endnew text begin a representative of the officenew text end to perform
duties under this section, the ombudsman must determine that the individual is qualified to
perform the duties required by this section.

(b) deleted text beginAn individual designated as ombudsman staff under this sectiondeleted text endnew text begin A representative
of the office designated as a regional ombudsman
new text end must successfully complete an
orientation training conducted under the direction of the ombudsman or approved by the
ombudsman. Orientation training shall be at least 20 hours and will consist of training
in: investigation, dispute resolution, health care regulation, confidentiality, resident and
patients' rights, and health care reimbursement.

(c) The ombudsman shall develop and implement a continuing education program
for deleted text beginindividualsdeleted text endnew text begin representatives of the officenew text end designated as deleted text beginombudsman staffdeleted text end new text beginregional
ombudsmen
new text endunder this sectiondeleted text begin. The continuing education program shall bedeleted text endnew text begin, who shall
complete
new text end at least 60 hours annually.

(d) deleted text beginAn individualdeleted text endnew text begin A representative of the officenew text end designated as deleted text beginan ombudsmandeleted text end new text begina
certified ombudsman
new text end volunteer under this section must successfully complete an approved
orientation training course with a minimum curriculum including federal and state bills
of rights for long-term care residents, acute hospital patients and home care clients, the
Vulnerable Adults Act, confidentiality, and the role of the ombudsman.

(e) The ombudsman shall develop and implement a continuing education program
for new text begincertified new text endombudsman volunteers deleted text beginwhich will providedeleted text endnew text begin, who shall completenew text end a minimum of
12 hours of continuing education per year.

(f) The ombudsman may withdraw deleted text beginan individual'sdeleted text endnew text begin a representative'snew text end designation if
the deleted text beginindividualdeleted text endnew text begin representativenew text end fails to perform duties of this section or meet continuing
education requirements. The deleted text beginindividualdeleted text end new text beginrepresentative new text endmay request a reconsideration of
such action by the Board on Aging deleted text beginwhose decisiondeleted text endnew text begin, but any further decision of the state
ombudsman about designation
new text end shall be final.

Subd. 2.

Immunity from liability.

The ombudsman deleted text beginor designee including staff
and volunteers under this section is
deleted text end new text beginand representatives of the office are new text endimmune from
civil liability that otherwise might result from the person's actions or omissions if the
person's actions are in good faith, are within the scope of the person's responsibilities as an
ombudsman or designee, and do not constitute willful or reckless misconduct.

Subd. 3.

Posting.

Every long-term care facility and acute care facility shall post
in a conspicuous place the address and telephone number of the office. A home care
service provider shall provide all recipients, including those in housing with services
under chapter 144D, with the address and telephone number of the office. Counties shall
provide clients receiving long-term care consultation services under section 256B.0911 or
home and community-based services through a state or federally funded program with
the name, address, and telephone number of the office. The posting or notice is subject
to approval by the ombudsman.

Subd. 4.

Access to long-term care and acute care facilities and clients.

The
ombudsman or designee may:

(1) enter any long-term care facility without notice at any time;

(2) enter any acute care facility without notice during normal business hours;

(3) enter any acute care facility without notice at any time to interview a patient or
observe services being provided to the patient as part of an investigation of a matter that is
within the scope of the ombudsman's authority, but only if the ombudsman's or designee's
presence does not intrude upon the privacy of another patient or interfere with routine
hospital services provided to any patient in the facility;

(4) communicate privately and without restriction with any client, as long as the
ombudsman has the client's consent for such communication;

(5) inspect records of a long-term care facility, home care service provider, or
acute care facility that pertain to the care of the client according to sections 144.291 to
144.298; and

(6) with the consent of a client or client's legal guardian, the ombudsman or
designated staff shall have access to review records pertaining to the care of the client
according to sections 144.291 to 144.298. If a client cannot consent and has no legal
guardian, access to the records is authorized by this section.

A person who denies access to the ombudsman or designee in violation of this
subdivision or aids, abets, invites, compels, or coerces another to do so is guilty of a
misdemeanor.

Subd. 5.

Access to state records.

The ombudsman or designee, excluding
volunteers, has access to data of a state agency necessary for the discharge of the
ombudsman's duties, including records classified confidential or private under chapter 13,
or any other law. The data requested must be related to a specific case and is subject
to section 13.03, subdivision 4. If the data concerns an individual, the ombudsman or
designee shall first obtain the individual's consent. If the individual cannot consent and
has no legal guardian, then access to the data is authorized by this section.

Each state agency responsible for licensing, regulating, and enforcing state and
federal laws and regulations concerning long-term care, home care service providers,
and acute care facilities shall forward to the ombudsman on a quarterly basis, copies of
all correction orders, penalty assessments, and complaint investigation reports, for all
long-term care facilities, acute care facilities, and home care service providers.

Subd. 6.

Prohibition against discrimination or retaliation.

(a) No entity shall
take discriminatory, disciplinary, or retaliatory action against deleted text beginan employee or volunteerdeleted text endnew text begin the
ombudsman, representative of the office
new text end, or a deleted text beginpatient, residentdeleted text endnew text begin clientnew text end, or guardian or family
member of a deleted text beginpatient, resident, or guardiandeleted text endnew text begin client,new text end for filing in good faith a complaint
with or providing information to the ombudsman or deleted text begindesignee including volunteers
deleted text endnew text beginrepresentative of the officenew text end. A person who violates this subdivision or who aids, abets,
invites, compels, or coerces another to do so is guilty of a misdemeanor.

(b) There shall be a rebuttable presumption that any adverse action, as defined below,
within 90 days of report, is discriminatory, disciplinary, or retaliatory. For the purpose
of this clause, the term "adverse action" refers to action taken by the entity involved in a
report against the person making the report or the person with respect to whom the report
was made because of the report, and includes, but is not limited to:

(1) discharge or transfer from a facility;

(2) termination of service;

(3) restriction or prohibition of access to the facility or its residents;

(4) discharge from or termination of employment;

(5) demotion or reduction in remuneration for services; and

(6) any restriction of rights set forth in section 144.651, 144A.44, or 144A.751.

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 2

CHEMICAL AND MENTAL HEALTH SERVICES

Section 1.

Minnesota Statutes 2014, section 245.462, subdivision 18, is amended to read:


Subd. 18.

Mental health professional.

"Mental health professional" means a
person providing clinical services in the treatment of mental illness who is qualified in at
least one of the following ways:

(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171
to 148.285; and:

(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or

(ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;

(2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;

(3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;

(4) in psychiatry: a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification in
psychiatrynew text begin, or an osteopathic physician licensed under chapter 147 and certified by
the American Osteopathic Board of Neurology and Psychiatry or eligible for board
certification in psychiatry
new text end;

(5) in marriage and family therapy: the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness;

(6) in licensed professional clinical counseling, the mental health professional
shall be a licensed professional clinical counselor under section 148B.5301 with at least
4,000 hours of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness; or

(7) in allied fields: a person with a master's degree from an accredited college or
university in one of the behavioral sciences or related fields, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness.

Sec. 2.

Minnesota Statutes 2014, section 245.4871, subdivision 27, is amended to read:


Subd. 27.

Mental health professional.

"Mental health professional" means a
person providing clinical services in the diagnosis and treatment of children's emotional
disorders. A mental health professional must have training and experience in working with
children consistent with the age group to which the mental health professional is assigned.
A mental health professional must be qualified in at least one of the following ways:

(1) in psychiatric nursing, the mental health professional must be a registered nurse
who is licensed under sections 148.171 to 148.285 and who is certified as a clinical
specialist in child and adolescent psychiatric or mental health nursing by a national nurse
certification organization or who has a master's degree in nursing or one of the behavioral
sciences or related fields from an accredited college or university or its equivalent, with
at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of mental illness;

(2) in clinical social work, the mental health professional must be a person licensed
as an independent clinical social worker under chapter 148D, or a person with a master's
degree in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders;

(3) in psychology, the mental health professional must be an individual licensed by
the board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;

(4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible
for board certification in psychiatrynew text begin or an osteopathic physician licensed under chapter
147 and certified by the American Osteopathic Board of Neurology and Psychiatry or
eligible for board certification in psychiatry
new text end;

(5) in marriage and family therapy, the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in the
treatment of mental disorders or emotional disturbances;

(6) in licensed professional clinical counseling, the mental health professional shall
be a licensed professional clinical counselor under section 148B.5301 with at least 4,000
hours of post-master's supervised experience in the delivery of clinical services in the
treatment of mental disorders or emotional disturbances; or

(7) in allied fields, the mental health professional must be a person with a master's
degree from an accredited college or university in one of the behavioral sciences or related
fields, with at least 4,000 hours of post-master's supervised experience in the delivery of
clinical services in the treatment of emotional disturbances.

Sec. 3.

Minnesota Statutes 2014, section 256B.0615, subdivision 1, is amended to read:


Subdivision 1.

Scope.

Medical assistance covers mental health certified deleted text beginpeers
specialists
deleted text endnew text begin peer specialist new text end services, as established in subdivision 2, subject to federal
approval, if provided to recipients who are eligible for services under sections 256B.0622,
256B.0623, and 256B.0624 and are provided by a certified peer specialist who has
completed the training under subdivision 5.

Sec. 4.

Minnesota Statutes 2014, section 256B.0615, subdivision 2, is amended to read:


Subd. 2.

Establishment.

The commissioner of human services shall establish a
certified peer deleted text beginspecialistsdeleted text endnew text begin specialistnew text end program model, which:

(1) provides nonclinical peer support counseling by certified peer specialists;

(2) provides a part of a wraparound continuum of services in conjunction with
other community mental health services;

(3) is individualized to the consumer; and

(4) promotes socialization, recovery, self-sufficiency, self-advocacy, development of
natural supports, and maintenance of skills learned in other support services.

Sec. 5.

Minnesota Statutes 2014, section 256B.0622, as amended by Laws 2015,
chapter 71, article 2, sections 23 to 32, is amended to read:


256B.0622 deleted text beginINTENSIVE REHABILITATIVE MENTAL HEALTH SERVICES
deleted text endnew text beginASSERTIVE COMMUNITY TREATMENT AND INTENSIVE RESIDENTIAL
TREATMENT SERVICES
new text end.

Subdivision 1.

Scope.

Subject to federal approval, medical assistance covers
medically necessary, assertive community treatmentnew text begin for clients as defined in subdivision
2a
new text end and intensive residential treatment services deleted text beginas defined in subdivision 2,deleted text end for deleted text beginrecipients
deleted text endnew text beginclientsnew text end as defined in subdivision 3, when the services are provided by an entity meeting the
standards in this section.

Subd. 2.

Definitions.

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

new text begin (b) "ACT team" means the group of interdisciplinary mental health staff who work
as a team to provide assertive community treatment.
new text end

deleted text begin (a)deleted text endnew text begin (c)new text end "Assertive community treatment" means intensive nonresidential new text begintreatment
and
new text endrehabilitative mental health services provided according to the deleted text beginevidence-based practice
of
deleted text end assertive community treatmentnew text begin model. Assertive community treatment provides a
single, fixed point of responsibility for treatment, rehabilitation, and support needs for
clients. Services are offered 24 hours per day, seven days per week, in a community-based
setting
new text end. deleted text beginCore elements of this service include, but are not limited to:
deleted text end

deleted text begin (1) a multidisciplinary staff who utilize a total team approach and who serve as a
fixed point of responsibility for all service delivery;
deleted text end

deleted text begin (2) providing services 24 hours per day and seven days per week;
deleted text end

deleted text begin (3) providing the majority of services in a community setting;
deleted text end

deleted text begin (4) offering a low ratio of recipients to staff; and
deleted text end

deleted text begin (5) providing service that is not time-limited.
deleted text end

new text begin (d) "Individual treatment plan" means the document that results from a
person-centered planning process of determining real-life outcomes with clients and
developing strategies to achieve those outcomes.
new text end

new text begin (e) "Assertive engagement" means the use of collaborative strategies to engage
clients to receive services.
new text end

new text begin (f) "Benefits and finance support" means assisting clients in capably managing
financial affairs. Services include, but are not limited to, assisting clients in applying for
benefits; assisting with redetermination of benefits; providing financial crisis management;
teaching and supporting budgeting skills and asset development; and coordinating with a
client's representative payee, if applicable.
new text end

new text begin (g) "Co-occurring disorder treatment" means the treatment of co-occurring mental
illness and substance use disorders and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each stage
of treatment. Services include, but are not limited to, assessing and tracking clients' stages
of change readiness and treatment; applying the appropriate treatment based on stages
of change, such as outreach and motivational interviewing techniques to work with
clients in earlier stages of change readiness and cognitive behavioral approaches and
relapse prevention to work with clients in later stages of change; and facilitating access
to community supports.
new text end

new text begin (h) "Crisis assessment and intervention" means mental health crisis response services
as defined in section 256B.0624, subdivision 2, paragraphs (c) to (e).
new text end

new text begin (i) "Employment services" means assisting clients to work at jobs of their choosing.
Services must follow the principles of the individual placement and support (IPS)
employment model, including focusing on competitive employment; emphasizing
individual client preferences and strengths; ensuring employment services are integrated
with mental health services; conducting rapid job searches and systematic job development
according to client preferences and choices; providing benefits counseling; and offering
all services in an individualized and time-unlimited manner. Services shall also include
educating clients about opportunities and benefits of work and school and assisting the
client in learning job skills, navigating the work place, and managing work relationships.
new text end

new text begin (j) "Family psychoeducation and support" means services provided to the client's
family and other natural supports to restore and strengthen the client's unique social
and family relationships. Services include, but are not limited to, individualized
psychoeducation about the client's illness and the role of the family and other significant
people in the therapeutic process; family intervention to restore contact, resolve conflict,
and maintain relationships with family and other significant people in the client's life;
ongoing communication and collaboration between the ACT team and the family;
introduction and referral to family self-help programs and advocacy organizations that
promote recovery and family engagement, individual supportive counseling, parenting
training, and service coordination to help clients fulfill parenting responsibilities;
coordinating services for the child and restoring relationships with children who are not in
the client's custody; and coordinating with child welfare and family agencies, if applicable.
These services must be provided with the client's agreement and consent.
new text end

new text begin (k) "Housing access support" means assisting clients to find, obtain, retain, and
move to safe and adequate housing of their choice. Housing access support includes,
but is not limited to, locating housing options with a focus on integrated independent
settings; applying for housing subsidies, programs, or resources; assisting the client in
developing relationships with local landlords; providing tenancy support and advocacy for
the individual's tenancy rights at the client's home; and assisting with relocation.
new text end

new text begin (l) "Individual treatment team" means a minimum of three members of the ACT
team who are responsible for consistently carrying out most of a client's assertive
community treatment services.
new text end

new text begin (m) "Intensive residential treatment services treatment team" means all staff
who provide intensive residential treatment services under this section to clients. At
a minimum, this includes the clinical supervisor, mental health professionals as defined
in section 245.462, subdivision 18, clauses (1) to (6); mental health practitioners as
defined in section 245.462, subdivision 17; mental health rehabilitation workers under
section 256B.0623, subdivision 5, clause (4); and mental health certified peer specialists
under section 256B.0615.
new text end

deleted text begin (b)deleted text endnew text begin (n)new text end "Intensive residential treatment services" means short-term, time-limited
services provided in a residential setting to deleted text beginrecipientsdeleted text endnew text begin clientsnew text end who are in need of more
restrictive settings and are at risk of significant functional deterioration if they do not receive
these services. Services are designed to develop and enhance psychiatric stability, personal
and emotional adjustment, self-sufficiency, and skills to live in a more independent setting.
Services must be directed toward a targeted discharge date with specified client outcomes.

deleted text begin (c) "Evidence-based practices" are nationally recognized mental health services that
are proven by substantial research to be effective in helping individuals with serious
mental illness obtain specific treatment goals.
deleted text end

new text begin (o) "Medication assistance and support" means assisting clients in accessing
medication, developing the ability to take medications with greater independence, and
providing medication setup. This includes the prescription, administration, and order of
medication by appropriate medical staff.
new text end

new text begin (p) "Medication education" means educating clients on the role and effects of
medications in treating symptoms of mental illness and the side effects of medications.
new text end

deleted text begin (d)deleted text endnew text begin (q)new text end "Overnight staff" means a member of the intensive residential deleted text beginrehabilitative
mental health
deleted text end treatment new text beginservices new text endteam who is responsible during hours when deleted text beginrecipients
deleted text endnew text beginclientsnew text end are typically asleep.

deleted text begin (e) "Treatment team" means all staff who provide services under this section to
recipients. At a minimum, this includes the clinical supervisor, mental health professionals
as defined in section 245.462, subdivision 18, clauses (1) to (6); mental health practitioners
as defined in section 245.462, subdivision 17; mental health rehabilitation workers under
section 256B.0623, subdivision 5, clause (3); and certified peer specialists under section
256B.0615.
deleted text end

new text begin (r) "Mental health certified peer specialist services" has the meaning given in
section 256B.0615.
new text end

new text begin (s) "Physical health services" means any service or treatment to meet the physical
health needs of the client to support the client's mental health recovery. Services include,
but are not limited to, education on primary health issues, including wellness education;
medication administration and monitoring; providing and coordinating medical screening
and follow-up; scheduling routine and acute medical and dental care visits; tobacco
cessation strategies; assisting clients in attending appointments; communicating with other
providers; and integrating all physical and mental health treatment.
new text end

new text begin (t) "Primary team member" means the person who leads and coordinates the
activities of the individual treatment team and is the individual treatment team member
who has primary responsibility for establishing and maintaining a therapeutic relationship
with the client on a continuing basis.
new text end

new text begin (u) "Rehabilitative mental health services" means mental health services that are
rehabilitative and enable the client to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills,
and community skills, when these abilities are impaired by the symptoms of mental illness.
new text end

new text begin (v) "Symptom management" means supporting clients in identifying and targeting
the symptoms and occurrence patterns of their mental illness and developing strategies
to reduce the impact of those symptoms.
new text end

new text begin (w) "Therapeutic interventions" means empirically supported techniques to address
specific symptoms and behaviors such as anxiety, psychotic symptoms, emotional
dysregulation, and trauma symptoms. Interventions include empirically supported
psychotherapies including, but not limited to, cognitive behavioral therapy, exposure
therapy, acceptance and commitment therapy, interpersonal therapy, and motivational
interviewing.
new text end

new text begin (x) "Wellness self-management and prevention" means a combination of approaches
to working with the client to build and apply skills related to recovery, and to support
the client in participating in leisure and recreational activities, civic participation, and
meaningful structure.
new text end

new text begin Subd. 2a. new text end

new text begin Eligibility for assertive community treatment. new text end

new text begin An eligible client
for assertive community treatment is an individual who meets the following criteria as
assessed by an ACT team:
new text end

new text begin (1) is age 18 or older. Individuals ages 16 and 17 may be eligible upon approval by
the commissioner;
new text end

new text begin (2) has a primary diagnosis of schizophrenia, schizoaffective disorder, major
depressive disorder with psychotic features, other psychotic disorders, or bipolar disorder.
Individuals with other psychiatric illnesses may qualify for assertive community treatment
if they have a serious mental illness and meet the criteria outlined in clauses (3) and (4), but
no more than ten percent of an ACT team's clients may be eligible based on this criteria.
Individuals with a primary diagnosis of a substance use disorder, intellectual developmental
disabilities, borderline personality disorder, antisocial personality disorder, traumatic brain
injury, or an autism spectrum disorder are not eligible for assertive community treatment;
new text end

new text begin (3) has significant functional impairment as demonstrated by at least one of the
following conditions:
new text end

new text begin (i) significant difficulty consistently performing the range of routine tasks required
for basic adult functioning in the community or persistent difficulty performing daily
living tasks without significant support or assistance;
new text end

new text begin (ii) significant difficulty maintaining employment at a self-sustaining level or
significant difficulty consistently carrying out the head-of-household responsibilities; or
new text end

new text begin (iii) significant difficulty maintaining a safe living situation;
new text end

new text begin (4) has a need for continuous high-intensity services as evidenced by at least two of
the following:
new text end

new text begin (i) two or more psychiatric hospitalizations or residential crisis stabilization services
in the previous 12 months;
new text end

new text begin (ii) frequent utilization of mental health crisis services in the previous six months;
new text end

new text begin (iii) 30 or more consecutive days of psychiatric hospitalization in the previous
24 months;
new text end

new text begin (iv) intractable, persistent, or prolonged severe psychiatric symptoms;
new text end

new text begin (v) coexisting mental health and substance use disorders lasting at least six months;
new text end

new text begin (vi) recent history of involvement with the criminal justice system or demonstrated
risk of future involvement;
new text end

new text begin (vii) significant difficulty meeting basic survival needs;
new text end

new text begin (viii) residing in substandard housing, experiencing homelessness, or facing
imminent risk of homelessness;
new text end

new text begin (ix) significant impairment with social and interpersonal functioning such that basic
needs are in jeopardy;
new text end

new text begin (x) coexisting mental health and physical health disorders lasting at least six months;
new text end

new text begin (xi) residing in an inpatient or supervised community residence but clinically assessed
to be able to live in a more independent living situation if intensive services are provided;
new text end

new text begin (xii) requiring a residential placement if more intensive services are not available; or
new text end

new text begin (xiii) difficulty effectively using traditional office-based outpatient services;
new text end

new text begin (5) there are no indications that other available community-based services would
be equally or more effective as evidenced by consistent and extensive efforts to treat
the individual; and
new text end

new text begin (6) in the written opinion of a licensed mental health professional, has the need for
mental health services that cannot be met with other available community-based services,
or is likely to experience a mental health crisis or require a more restrictive setting if
assertive community treatment is not provided.
new text end

new text begin Subd. 2b. new text end

new text begin Continuing stay and discharge criteria for assertive community
treatment.
new text end

new text begin (a) A client receiving assertive community treatment is eligible to continue
receiving services if:
new text end

new text begin (1) the client has not achieved the desired outcomes of their individual treatment plan;
new text end

new text begin (2) the client's level of functioning has not been restored, improved, or sustained
over the time frame outlined in the individual treatment plan;
new text end

new text begin (3) the client continues to be at risk for relapse based on current clinical assessment,
history, or the tenuous nature of the functional gains; or
new text end

new text begin (4) the client is functioning effectively with this service and discharge would
otherwise be indicated but without continued services the client's functioning would
decline; and
new text end

new text begin (5) one of the following must also apply:
new text end

new text begin (i) the client has achieved current individual treatment plan goals but additional
goals are indicated as evidenced by documented symptoms;
new text end

new text begin (ii) the client is making satisfactory progress toward meeting goals and there
is documentation that supports that continuation of this service shall be effective in
addressing the goals outlined in the individual treatment plan;
new text end

new text begin (iii) the client is making progress, but the specific interventions in the individual
treatment plan need to be modified so that greater gains, which are consistent with the
client's potential level of functioning, are possible; or
new text end

new text begin (iv) the client fails to make progress or demonstrates regression in meeting goals
through the interventions outlined in the individual treatment plan.
new text end

new text begin (b) Clients receiving assertive community treatment are eligible to be discharged if
they meet at least one of the following criteria:
new text end

new text begin (1) the client and the ACT team determine that assertive community treatment
services are no longer needed based on the attainment of goals as identified in the individual
treatment plan and a less intensive level of care would adequately address current goals;
new text end

new text begin (2) the client moves out of the ACT team's service area and the ACT team has
facilitated the referral to either a new ACT team or other appropriate mental health service
and has assisted the individual in the transition process;
new text end

new text begin (3) the client, or the client's legal guardian when applicable, chooses to withdraw
from assertive community treatment services and documented attempts by the ACT team
to re-engage the client with the service have not been successful;
new text end

new text begin (4) the client has a demonstrated need for a medical nursing home placement lasting
more than three months, as determined by a physician;
new text end

new text begin (5) the client is hospitalized, in residential treatment, or in jail for a period of greater
than three months. However, the ACT team must make provisions for the client to return to
the ACT team upon their discharge or release from the hospital or jail if the client still meets
eligibility criteria for assertive community treatment and the team is not at full capacity;
new text end

new text begin (6) the ACT team is unable to locate, contact, and engage the client for a period of
greater than three months after persistent efforts by the ACT team to locate the client; or
new text end

new text begin (7) the client requests a discharge, despite repeated and proactive efforts by the ACT
team to engage the client in service planning. The ACT team must develop a transition
plan to arrange for alternate treatment for clients in this situation who have a history of
suicide attempts, assault, or forensic involvement.
new text end

new text begin (c) For all clients who are discharged from assertive community treatment to another
service provider within the ACT team's service area there is a three-month transfer period,
from the date of discharge, during which a client who does not adjust well to the new
service, may voluntarily return to the ACT team. During this period, the ACT team must
maintain contact with the client's new service provider.
new text end

Subd. 3.

Eligibilitynew text begin for intensive residential treatment servicesnew text end.

An eligible
deleted text beginrecipientdeleted text endnew text begin client for intensive residential treatment servicesnew text end is an individual who:

(1) is age 18 or older;

(2) is eligible for medical assistance;

(3) is diagnosed with a mental illness;

(4) because of a mental illness, has substantial disability and functional impairment
in three or more of the areas listed in section 245.462, subdivision 11a, so that
self-sufficiency is markedly reduced;

(5) has one or more of the following: a history of recurring or prolonged inpatient
hospitalizations in the past year, significant independent living instability, homelessness,
or very frequent use of mental health and related services yielding poor outcomes; and

(6) in the written opinion of a licensed mental health professional, has the need for
mental health services that cannot be met with other available community-based services,
or is likely to experience a mental health crisis or require a more restrictive setting if
intensive rehabilitative mental health services are not provided.

new text begin Subd. 3a. new text end

new text begin Provider certification and contract requirements for assertive
community treatment.
new text end

new text begin (a) The assertive community treatment provider must:
new text end

new text begin (1) have a contract with the host county to provide assertive community treatment
services; and
new text end

new text begin (2) have each ACT team be certified by the state following the certification process
and procedures developed by the commissioner. The certification process determines
whether the ACT team meets the standards for assertive community treatment under
this section as well as minimum program fidelity standards as measured by a nationally
recognized fidelity tool approved by the commissioner. Recertification must occur at least
every three years.
new text end

new text begin (b) An ACT team certified under this subdivision must meet the following standards:
new text end

new text begin (1) have capacity to recruit, hire, manage, and train required ACT team members;
new text end

new text begin (2) have adequate administrative ability to ensure availability of services;
new text end

new text begin (3) ensure adequate preservice and ongoing training for staff;
new text end

new text begin (4) ensure that staff is capable of implementing culturally specific services that are
culturally responsive and appropriate as determined by the client's culture, beliefs, values,
and language as identified in the individual treatment plan;
new text end

new text begin (5) ensure flexibility in service delivery to respond to the changing and intermittent
care needs of a client as identified by the client and the individual treatment plan;
new text end

new text begin (6) develop and maintain client files, individual treatment plans, and contact charting;
new text end

new text begin (7) develop and maintain staff training and personnel files;
new text end

new text begin (8) submit information as required by the state;
new text end

new text begin (9) keep all necessary records required by law;
new text end

new text begin (10) comply with all applicable laws;
new text end

new text begin (11) be an enrolled Medicaid provider;
new text end

new text begin (12) establish and maintain a quality assurance plan to determine specific service
outcomes and the client's satisfaction with services; and
new text end

new text begin (13) develop and maintain written policies and procedures regarding service
provision and administration of the provider entity.
new text end

new text begin (c) The commissioner may intervene at any time and decertify an ACT team with
cause. The commissioner shall establish a process for decertification of an ACT team and
shall require corrective action, medical assistance repayment, or decertification of an
ACT team that no longer meets the requirements in this section or that fails to meet the
clinical quality standards or administrative standards provided by the commissioner in the
application and certification process. The decertification is subject to appeal to the state.
new text end

Subd. 4.

Provider deleted text begincertificationdeleted text endnew text begin licensurenew text end and contract requirementsnew text begin for intensive
residential treatment services
new text end.

deleted text begin (a) The assertive community treatment provider must:
deleted text end

deleted text begin (1) have a contract with the host county to provide intensive adult rehabilitative
mental health services; and
deleted text end

deleted text begin (2) be certified by the commissioner as being in compliance with this section and
section 256B.0623.
deleted text end

deleted text begin (b)deleted text endnew text begin (a)new text end The intensive residential treatment services provider must:

(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;

(2) not exceed 16 beds per site;

(3) comply with the additional standards in this section; and

(4) have a contract with the host county to provide these services.

deleted text begin (c)deleted text endnew text begin (b)new text end The commissioner shall develop procedures for counties and providers
to submit contracts and other documentation as needed to allow the commissioner to
determine whether the standards in this section are met.

deleted text begin Subd. 5. deleted text end

deleted text begin Standards applicable to both assertive community treatment and
residential providers.
deleted text end

deleted text begin (a) Services must be provided by qualified staff as defined in section
256B.0623, subdivision 5, who are trained and supervised according to section 256B.0623,
subdivision 6
, except that mental health rehabilitation workers acting as overnight staff are
not required to comply with section 256B.0623, subdivision 5, clause (4), item (iv).
deleted text end

deleted text begin (b) The clinical supervisor must be an active member of the treatment team. The
treatment team must meet with the clinical supervisor at least weekly to discuss recipients'
progress and make rapid adjustments to meet recipients' needs. The team meeting shall
include recipient-specific case reviews and general treatment discussions among team
members. Recipient-specific case reviews and planning must be documented in the
individual recipient's treatment record.
deleted text end

deleted text begin (c) Treatment staff must have prompt access in person or by telephone to a mental
health practitioner or mental health professional. The provider must have the capacity to
promptly and appropriately respond to emergent needs and make any necessary staffing
adjustments to assure the health and safety of recipients.
deleted text end

deleted text begin (d) The initial functional assessment must be completed within ten days of intake
and updated at least every 30 days for intensive residential treatment services and every
six months for assertive community treatment, or prior to discharge from the service,
whichever comes first.
deleted text end

deleted text begin (e) The initial individual treatment plan must be completed within ten days of
intake for assertive community treatment and within 24 hours of admission for intensive
residential treatment services. Within ten days of admission, the initial treatment plan
must be refined and further developed for intensive residential treatment services, except
for providers certified according to Minnesota Rules, parts 9533.0010 to 9533.0180.
The individual treatment plan must be reviewed with the recipient and updated at least
monthly for intensive residential treatment services and at least every six months for
assertive community treatment.
deleted text end

deleted text begin Subd. 6. deleted text end

deleted text begin Standards for intensive residential rehabilitative mental health services.
deleted text end

deleted text begin (a) The provider of intensive residential services must have sufficient staff to provide
24-hour-per-day coverage to deliver the rehabilitative services described in the treatment
plan and to safely supervise and direct the activities of recipients given the recipient's level
of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider
must have the capacity within the facility to provide integrated services for chemical
dependency, illness management services, and family education when appropriate.
deleted text end

deleted text begin (b) At a minimum:
deleted text end

deleted text begin (1) staff must be available and provide direction and supervision whenever recipients
are present in the facility;
deleted text end

deleted text begin (2) staff must remain awake during all work hours;
deleted text end

deleted text begin (3) there must be a staffing ratio of at least one to nine recipients for each day and
evening shift. If more than nine recipients are present at the residential site, there must be
a minimum of two staff during day and evening shifts, one of whom must be a mental
health practitioner or mental health professional;
deleted text end

deleted text begin (4) if services are provided to recipients who need the services of a medical
professional, the provider shall assure that these services are provided either by the
provider's own medical staff or through referral to a medical professional; and
deleted text end

deleted text begin (5) the provider must assure the timely availability of a licensed registered
nurse, either directly employed or under contract, who is responsible for ensuring the
effectiveness and safety of medication administration in the facility and assessing patients
for medication side effects and drug interactions.
deleted text end

new text begin Subd. 5a. new text end

new text begin Standards for intensive residential rehabilitative mental health
services.
new text end

new text begin (a) The standards in this subdivision apply to intensive residential mental health
services.
new text end

new text begin (b) The provider of intensive residential treatment services must have sufficient staff
to provide 24-hour-per-day coverage to deliver the rehabilitative services described in the
treatment plan and to safely supervise and direct the activities of clients, given the client's
level of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider
must have the capacity within the facility to provide integrated services for chemical
dependency, illness management services, and family education, when appropriate.
new text end

new text begin (c) At a minimum:
new text end

new text begin (1) staff must provide direction and supervision whenever clients are present in
the facility;
new text end

new text begin (2) staff must remain awake during all work hours;
new text end

new text begin (3) there must be a staffing ratio of at least one to nine clients for each day and
evening shift. If more than nine clients are present at the residential site, there must be a
minimum of two staff during day and evening shifts, one of whom must be a mental health
practitioner or mental health professional;
new text end

new text begin (4) if services are provided to clients who need the services of a medical professional,
the provider shall ensure that these services are provided either by the provider's own
medical staff or through referral to a medical professional; and
new text end

new text begin (5) the provider must ensure the timely availability of a licensed registered
nurse, either directly employed or under contract, who is responsible for ensuring the
effectiveness and safety of medication administration in the facility and assessing clients
for medication side effects and drug interactions.
new text end

new text begin (d) Services must be provided by qualified staff as defined in section 256B.0623,
subdivision 5, who are trained and supervised according to section 256B.0623, subdivision
6, except that mental health rehabilitation workers acting as overnight staff are not
required to comply with section 256B.0623, subdivision 5, clause (4), item (iv).
new text end

new text begin (e) The clinical supervisor must be an active member of the intensive residential
services treatment team. The team must meet with the clinical supervisor at least weekly
to discuss clients' progress and make rapid adjustments to meet clients' needs. The team
meeting shall include client-specific case reviews and general treatment discussions
among team members. Client-specific case reviews and planning must be documented
in the client's treatment record.
new text end

new text begin (f) Treatment staff must have prompt access in person or by telephone to a mental
health practitioner or mental health professional. The provider must have the capacity to
promptly and appropriately respond to emergent needs and make any necessary staffing
adjustments to ensure the health and safety of clients.
new text end

new text begin (g) The initial functional assessment must be completed within ten days of intake and
updated at least every 30 days, or prior to discharge from the service, whichever comes first.
new text end

new text begin (h) The initial individual treatment plan must be completed within 24 hours of
admission. Within ten days of admission, the initial treatment plan must be refined and
further developed, except for providers certified according to Minnesota Rules, parts
9533.0010 to 9533.0180. The individual treatment plan must be reviewed with the client
and updated at least monthly.
new text end

Subd. 7.

deleted text beginAdditional standards fordeleted text end Assertive community treatmentnew text begin service
standards
new text end.

deleted text begin The standards in this subdivision apply to assertive community treatment
services.
deleted text end

deleted text begin (1) The treatment team must use team treatment, not an individual treatment model.
deleted text end

deleted text begin (2) The clinical supervisor must function as a practicing clinician at least on a
part-time basis.
deleted text end

deleted text begin (3) The staffing ratio must not exceed ten recipients to one full-time equivalent
treatment team position.
deleted text end

deleted text begin (4) Services must be available at times that meet client needs.
deleted text end

deleted text begin (5) The treatment team must actively and assertively engage and reach out to the
recipient's family members and significant others, after obtaining the recipient's permission.
deleted text end

deleted text begin (6) The treatment team must establish ongoing communication and collaboration
between the team, family, and significant others and educate the family and significant
others about mental illness, symptom management, and the family's role in treatment.
deleted text end

deleted text begin (7) The treatment team must provide interventions to promote positive interpersonal
relationships.
deleted text end

new text begin (a) ACT teams must offer and have the capacity to directly provide the following
services:
new text end

new text begin (1) assertive engagement;
new text end

new text begin (2) benefits and finance support;
new text end

new text begin (3) co-occurring disorder treatment;
new text end

new text begin (4) crisis assessment and intervention;
new text end

new text begin (5) employment services;
new text end

new text begin (6) family psychoeducation and support;
new text end

new text begin (7) housing access support;
new text end

new text begin (8) medication assistance and support;
new text end

new text begin (9) medication education;
new text end

new text begin (10) mental health certified peer specialists services;
new text end

new text begin (11) physical health services;
new text end

new text begin (12) rehabilitative mental health services;
new text end

new text begin (13) symptom management;
new text end

new text begin (14) therapeutic interventions;
new text end

new text begin (15) wellness self-management and prevention; and
new text end

new text begin (16) other services based on client needs as identified in a client's assertive
community treatment individual treatment plan.
new text end

new text begin (b) ACT teams must ensure the provision of all services necessary to meet a client's
needs as identified in the client's individual treatment plan.
new text end

new text begin Subd. 7b. new text end

new text begin Assertive community treatment team staff requirements and roles.
new text end

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

new text begin (1) the team leader:
new text end

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

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

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

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

new text begin (2) the psychiatric care provider:
new text end

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

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

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

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

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

new text begin (vi) may not provide specific roles and responsibilities by telemedicine unless
approved by the commissioner; and
new text end

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

new text begin (3) the nursing staff:
new text end

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

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

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

new text begin (4) the co-occurring disorder specialist:
new text end

new text begin (i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and
how they affect mental illnesses, the ability to assess substance use disorders and the
client's stage of treatment, motivational interviewing, and skills necessary to provide
counseling to clients at all different stages of change and treatment. The co-occurring
disorder specialist may also be an individual who is a licensed alcohol and drug counselor
as described in section 148F.01, subdivision 5, or a counselor who otherwise meets the
training, experience, and other requirements in Minnesota Rules, part 9530.6450, subpart
5. No more than two co-occurring disorder specialists may occupy this role; and
new text end

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

new text begin (5) the vocational specialist:
new text end

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

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

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

new text begin (6) the mental health certified peer specialist:
new text end

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

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

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

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

new text begin (8) additional staff:
new text end

new text begin (i) shall be based on team size. Additional treatment team staff may include licensed
mental health professionals as defined in Minnesota Rules, part 9505.0371, subpart 5, item
A; mental health practitioners as defined in Minnesota Rules, part 9505.0370, subpart 17;
or mental health rehabilitation workers as defined in section 256B.0623, subdivision 5,
clause (4). These individuals shall have the knowledge, skills, and abilities required by the
population served to carry out rehabilitation and support functions; and
new text end

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

new text begin (b) Each ACT team must clearly document schedules for all ACT team members.
new text end

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

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

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

new text begin Subd. 7c. new text end

new text begin Assertive community treatment program size and opportunities. new text end

new text begin (a)
Each ACT team shall maintain an annual average caseload that does not exceed 100
clients. Staff-to-client ratios shall be based on team size as follows:
new text end

new text begin (1) a small ACT team must:
new text end

new text begin (i) employ at least six but no more than seven full-time treatment team staff,
excluding the program assistant and the psychiatric care provider;
new text end

new text begin (ii) serve an annual average maximum of no more than 50 clients;
new text end

new text begin (iii) ensure at least one full-time equivalent position for every eight clients served;
new text end

new text begin (iv) schedule ACT team staff for at least eight-hour shift coverage on weekdays and
on-call duty to provide crisis services and deliver services after hours when staff are not
working;
new text end

new text begin (v) provide crisis services during business hours if the small ACT team does not
have sufficient staff numbers to operate an after-hours on-call system. During all other
hours, the ACT team may arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and
the on-call ACT team staff are available to see clients face-to-face when necessary or if
requested by the crisis-intervention services provider;
new text end

new text begin (vi) adjust schedules and provide staff to carry out the needed service activities in
the evenings or on weekend days or holidays, when necessary;
new text end

new text begin (vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup
must be arranged and a mechanism of timely communication and coordination established
in writing;
new text end

new text begin (viii) be composed of, at minimum, one full-time team leader, at least 16 hours
each week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one
full-time equivalent nursing, one full-time substance abuse specialist, one full-time
equivalent mental health certified peer specialist, one full-time vocational specialist, one
full-time program assistant, and at least one additional full-time ACT team member who
has mental health professional or practitioner status; and
new text end

new text begin (2) a midsize ACT team shall:
new text end

new text begin (i) be composed of, at minimum, one full-time team leader, at least 16 hours of
psychiatry time for 51 clients, with an additional two hours for every six clients added
to the team, 1.5 to two full-time equivalent nursing staff, one full-time substance abuse
specialist, one full-time equivalent mental health certified peer specialist, one full-time
vocational specialist, one full-time program assistant, and at least 1.5 to two additional
full-time equivalent ACT members, with at least one dedicated full-time staff member
with mental health professional status. Remaining team members may have mental health
professional or practitioner status;
new text end

new text begin (ii) employ seven or more treatment team full-time equivalents, excluding the
program assistant and the psychiatric care provider;
new text end

new text begin (iii) serve an annual average maximum caseload of 51 to 74 clients;
new text end

new text begin (iv) ensure at least one full-time equivalent position for every nine clients served;
new text end

new text begin (v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these
minimum specifications, staff are regularly scheduled to provide the necessary services on
a client-by-client basis in the evenings and on weekends and holidays;
new text end

new text begin (vi) schedule ACT team staff on-call duty to provide crisis services and deliver
services when staff are not working;
new text end

new text begin (vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and
the on-call ACT team staff are available to see clients face-to-face when necessary or if
requested by the crisis-intervention services provider; and
new text end

new text begin (viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;
new text end

new text begin (3) a large ACT team must:
new text end

new text begin (i) be composed of, at minimum, one full-time team leader, at least 32 hours
each week per 100 clients, or equivalent of psychiatry time, three full-time equivalent
nursing staff, one full-time substance abuse specialist, one full-time equivalent mental
health certified peer specialist, one full-time vocational specialist, one full-time program
assistant, and at least two additional full-time equivalent ACT team members, with at least
one dedicated full-time staff member with mental health professional status. Remaining
team members may have mental health professional or mental health practitioner status;
new text end

new text begin (ii) employ nine or more treatment team full-time equivalents, excluding the
program assistant and psychiatric care provider;
new text end

new text begin (iii) serve an annual average maximum caseload of 75 to 100 clients;
new text end

new text begin (iv) ensure at least one full-time equivalent position for every nine individuals served;
new text end

new text begin (v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;
new text end

new text begin (vi) schedule ACT team staff on-call duty to provide crisis services and deliver
services when staff are not working; and
new text end

new text begin (vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.
new text end

new text begin (b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.
new text end

new text begin Subd. 7d. new text end

new text begin Assertive community treatment program organization and
communication requirements.
new text end

new text begin (a) An ACT team shall provide at least 75 percent of all
services in the community in nonoffice- or nonfacility-based settings.
new text end

new text begin (b) ACT team members must know all clients receiving services, and interventions
must be carried out with consistency and follow empirically supported practice.
new text end

new text begin (c) Each ACT team client shall be assigned an individual treatment team that is
determined by a variety of factors, including team members' expertise and skills, rapport,
and other factors specific to the individual's preferences. The majority of clients shall see
at least three ACT team members in a given month.
new text end

new text begin (d) The ACT team shall have the capacity to rapidly increase service intensity to a
client when the client's status requires it, regardless of geography, provide flexible service
in an individualized manner, and see clients on average three times per week for at least
120 minutes per week. Services must be available at times that meet client needs.
new text end

new text begin (e) ACT teams shall make deliberate efforts to assertively engage clients in services.
Input of family members, natural supports, and previous and subsequent treatment
providers is required in developing engagement strategies. ACT teams shall include the
client, identified family, and other support persons in the admission, initial assessment, and
planning process as primary stakeholders, meet with the client in the client's environment
at times of the day and week that honor the client's preferences, and meet clients at home
and in jails or prisons, streets, homeless shelters, or hospitals.
new text end

new text begin (f) ACT teams shall ensure that a process is in place for identifying individuals in
need of more or less assertive engagement. Interventions are monitored to determine the
success of these techniques and the need to adapt the techniques or approach accordingly.
new text end

new text begin (g) ACT teams shall conduct daily team meetings to systematically update clinically
relevant information, briefly discuss the status of assertive community treatment clients
over the past 24 hours, problem solve emerging issues, plan approaches to address and
prevent crises, and plan the service contacts for the following 24-hour period or weekend.
All team members scheduled to work shall attend this meeting.
new text end

new text begin (h) ACT teams shall maintain a clinical log that succinctly documents important
clinical information and develop a daily team schedule for the day's contacts based
on a central file of the clients' weekly or monthly schedules, which are derived from
interventions specified within the individual treatment plan. The team leader must have a
record to ensure that all assigned contacts are completed.
new text end

new text begin Subd. 7e. new text end

new text begin Assertive community treatment assessment and individual treatment
plan.
new text end

new text begin (a) An initial assessment, including a diagnostic assessment that meets the
requirements of Minnesota Rules, part 9505.0372, subpart 1, and a 30-day treatment plan
shall be completed the day of the client's admission to assertive community treatment by
the ACT team leader or the psychiatric care provider, with participation by designated
ACT team members and the client. The team leader, psychiatric care provider, or other
mental health professional designated by the team leader or psychiatric care provider, must
update the client's diagnostic assessment at least annually.
new text end

new text begin (b) An initial functional assessment must be completed within ten days of intake
and updated every six months for assertive community treatment, or prior to discharge
from the service, whichever comes first.
new text end

new text begin (c) Within 30 days of the client's assertive community treatment admission, the
ACT team shall complete an in-depth assessment of the domains listed under section
245.462, subdivision 11a.
new text end

new text begin (d) Each part of the in-depth assessment areas shall be completed by each respective
team specialist or an ACT team member with skill and knowledge in the area being
assessed. The assessments are based upon all available information, including that from
client interview family and identified natural supports, and written summaries from other
agencies, including police, courts, county social service agencies, outpatient facilities,
and inpatient facilities, where applicable.
new text end

new text begin (e) Between 30 and 45 days after the client's admission to assertive community
treatment, the entire ACT team must hold a comprehensive case conference, where
all team members, including the psychiatric provider, present information discovered
from the completed in-depth assessments and provide treatment recommendations. The
conference must serve as the basis for the first six-month treatment plan, which must
be written by the primary team member.
new text end

new text begin (f) The client's psychiatric care provider, primary team member, and individual
treatment team members shall assume responsibility for preparing the written narrative
of the results from the psychiatric and social functioning history timeline and the
comprehensive assessment.
new text end

new text begin (g) The primary team member and individual treatment team members shall be
assigned by the team leader in collaboration with the psychiatric care provider by the time
of the first treatment planning meeting or 30 days after admission, whichever occurs first.
new text end

new text begin (h) Individual treatment plans must be developed through the following treatment
planning process:
new text end

new text begin (1) The individual treatment plan shall be developed in collaboration with the client
and the client's preferred natural supports, and guardian, if applicable and appropriate.
The ACT team shall evaluate, together with each client, the client's needs, strengths,
and preferences and develop the individual treatment plan collaboratively. The ACT
team shall make every effort to ensure that the client and the client's family and natural
supports, with the client's consent, are in attendance at the treatment planning meeting,
are involved in ongoing meetings related to treatment, and have the necessary supports to
fully participate. The client's participation in the development of the individual treatment
plan shall be documented.
new text end

new text begin (2) The client and the ACT team shall work together to formulate and prioritize
the issues, set goals, research approaches and interventions, and establish the plan. The
plan is individually tailored so that the treatment, rehabilitation, and support approaches
and interventions achieve optimum symptom reduction, help fulfill the personal needs
and aspirations of the client, take into account the cultural beliefs and realities of the
individual, and improve all the aspects of psychosocial functioning that are important to
the client. The process supports strengths, rehabilitation, and recovery.
new text end

new text begin (3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for
each service need. The individual treatment plan must clearly specify the approaches
and interventions necessary for the client to achieve the individual goals, when the
interventions shall happen, and identify which ACT team member shall carry out the
approaches and interventions.
new text end

new text begin (4) The primary team member and the individual treatment team, together with the
client and the client's family and natural supports with the client's consent, are responsible
for reviewing and rewriting the treatment goals and individual treatment plan whenever
there is a major decision point in the client's course of treatment or at least every six months.
new text end

new text begin (5) The primary team member shall prepare a summary that thoroughly describes
in writing the client's and the individual treatment team's evaluation of the client's
progress and goal attainment, the effectiveness of the interventions, and the satisfaction
with services since the last individual treatment plan. The client's most recent diagnostic
assessment must be included with the treatment plan summary.
new text end

new text begin (6) The individual treatment plan and review must be signed or acknowledged by
the client, the primary team member, individual treatment team members, the team leader,
the psychiatric care provider, and all individual treatment team members. A copy of the
signed individual treatment plan is made available to the client.
new text end

new text begin Subd. 7f. new text end

new text begin ACT team variances. new text end

new text begin The commissioner may grant a variance to specific
requirements under subdivision 2a, 7b, 7c, or 7d for an ACT team when the ACT team
demonstrates an inability to meet the specific requirement and how the team shall ensure
the variance shall not negatively impact outcomes for clients. The commissioner may
require a plan of action for the ACT team to come into compliance with the specific
requirement being varied and establish specific time limits for the variance. A decision to
grant or deny a variance request is final and not subject to appeal.
new text end

Subd. 8.

Medical assistance payment for deleted text beginintensive rehabilitative mental health
services
deleted text endnew text begin assertive community treatment and intensive residential treatment servicesnew text end.

(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 deleted text beginrecipientdeleted text endnew text begin clientnew text end 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 deleted text beginrecipientdeleted text endnew text begin clientnew text end 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); and

(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;

(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 deleted text beginrecipientsdeleted text endnew text begin clientsnew text end 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 thenew text begin intensive residential treatment services
new text endtreatment team. Physician services, whether billed separately or included in the rate,
may be delivered by telemedicine. For purposes of this paragraph, "telemedicine" has
the meaning given to "mental health telemedicine" in section 256B.0625, subdivision 46,
when telemedicine 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.

Subd. 9.

Provider enrollment; rate setting for county-operated entities.

Counties
that employ their own staff to provide services under this section shall apply directly to the
commissioner for enrollment and rate setting. In this case, a county contract is not required.

Subd. 10.

Provider enrollment; rate setting for specialized program.

A county
contract is not required for a provider proposing to serve a subpopulation of eligible
deleted text beginrecipientsdeleted text endnew text begin clientsnew text end under the following circumstances:

(1) the provider demonstrates that the subpopulation to be served requires a
specialized program which is not available from county-approved entities; and

(2) the subpopulation to be served is of such a low incidence that it is not feasible to
develop a program serving a single county or regional group of counties.

Subd. 11.

Sustainability grants.

The commissioner may disburse grant funds
directly to intensive residential treatment services providers and assertive community
treatment providers to maintain access to these services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2016, for ACT teams certified
after January 1, 2016. For ACT teams certified before January 1, 2016, this section is
effective January 1, 2017.
new text end

Sec. 6.

Minnesota Statutes 2014, section 256B.0947, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For purposes of this section, the following terms have the
meanings given them.

(a) "Intensive nonresidential rehabilitative mental health services" means child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
ages 16 deleted text beginto 21deleted text endnew text begin, 17, 18, 19, or 20new text end with a serious mental illness or co-occurring mental illness
and substance abuse addiction who require intensive services to prevent admission to an
inpatient psychiatric hospital or placement in a residential treatment facility or who require
intensive services to step down from inpatient or residential care to community-based care.

(b) "Co-occurring mental illness and substance abuse addiction" means a dual
diagnosis of at least one form of mental illness and at least one substance use disorder.
Substance use disorders include alcohol or drug abuse or dependence, excluding nicotine
use.

(c) "Diagnostic assessment" has the meaning given to it in Minnesota Rules, part
9505.0370, subpart 11. A diagnostic assessment must be provided according to Minnesota
Rules, part 9505.0372, subpart 1, and for this section must incorporate a determination of
the youth's necessary level of care using a standardized functional assessment instrument
approved and periodically updated by the commissioner.

(d) "Education specialist" means an individual with knowledge and experience
working with youth regarding special education requirements and goals, special education
plans, and coordination of educational activities with health care activities.

(e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.

(f) "Integrated dual disorders treatment" means the integrated treatment of
co-occurring mental illness and substance use disorders by a team of cross-trained
clinicians within the same program, and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each
stage of treatment.

(g) "Medication education services" means services provided individually or in
groups, which focus on:

(1) educating the client and client's family or significant nonfamilial supporters
about mental illness and symptoms;

(2) the role and effects of medications in treating symptoms of mental illness; and

(3) the side effects of medications.

Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.

(h) "Peer specialist" means an employed team member who is a new text beginmental health
new text endcertified peer specialistnew text begin according to section 256B.0615new text end and also a former children's
mental health consumer who:

(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;

(2) assists younger peers to identify and achieve specific life goals;

(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;

(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;

(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and

(6) meets the following criteria:

(i) is at least 22 years of age;

(ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part
9505.0370, subpart 20, or co-occurring mental illness and substance abuse addiction;

(iii) is a former consumer of child and adolescent mental health services, or a former
or current consumer of adult mental health services for a period of at least two years;

(iv) has at least a high school diploma or equivalent;

(v) has successfully completed training requirements determined and periodically
updated by the commissioner;

(vi) is willing to disclose the individual's own mental health history to team members
and clients; and

(vii) must be free of substance use problems for at least one year.

(i) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.

(j) "Substance use disorders" means one or more of the disorders defined in the
diagnostic and statistical manual of mental disorders, current edition.

(k) "Transition services" means:

(1) activities, materials, consultation, and coordination that ensures continuity of
the client's care in advance of and in preparation for the client's move from one stage of
care or life to another by maintaining contact with the client and assisting the client to
establish provider relationships;

(2) providing the client with knowledge and skills needed posttransition;

(3) establishing communication between sending and receiving entities;

(4) supporting a client's request for service authorization and enrollment; and

(5) establishing and enforcing procedures and schedules.

A youth's transition from the children's mental health system and services to
the adult mental health system and services and return to the client's home and entry
or re-entry into community-based mental health services following discharge from an
out-of-home placement or inpatient hospital stay.

(l) "Treatment team" means all staff who provide services to recipients under this
section.

new text begin EFFECTIVE DATE. new text end

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

Sec. 7. new text beginSUBSTANCE USE DISORDER SYSTEM REFORM.
new text end

new text begin Subdivision 1. new text end

new text begin Authorization of substance use disorder treatment system reform.
new text end

new text begin The commissioner shall design a reform of Minnesota's substance use disorder treatment
system to ensure a full continuum of care for individuals with substance use disorders.
new text end

new text begin Subd. 2. new text end

new text begin Goals. new text end

new text begin The proposal outlined in subdivision 3 shall support the following
goals:
new text end

new text begin (1) improve and promote strategies to identify individuals with substance use issues
and disorders;
new text end

new text begin (2) ensure timely access to treatment and improve access to treatment;
new text end

new text begin (3) enhance clinical practices and promote clinical guidelines and decision-making
tools for serving people with substance use disorders;
new text end

new text begin (4) build aftercare and recovery support services;
new text end

new text begin (5) coordinate and consolidate funding streams, including local, state, and federal
funds, to maximize efficiency;
new text end

new text begin (6) increase use of quality and outcome measures to inform benefit design and
payment models; and
new text end

new text begin (7) coordinate treatment of substance use disorders with primary care, long-term
care, and the mental health delivery system when appropriate.
new text end

new text begin Subd. 3. new text end

new text begin Reform proposal. new text end

new text begin (a) The commissioner shall develop a reform proposal
that includes both systemic and practice reforms to develop a robust continuum of care
to effectively treat the physical, behavioral, and mental dimensions of substance use
disorders. The reform proposal shall include, but is not limited to:
new text end

new text begin (1) an assessment and access process that permits clients to present directly to a
service provider for a substance use disorder assessment and authorization of services;
new text end

new text begin (2) mechanisms for direct reimbursement of credentialed professionals;
new text end

new text begin (3) care coordination models to connect individuals with substance use disorder
to appropriate providers;
new text end

new text begin (4) peer support services for people in recovery from substance use disorders;
new text end

new text begin (5) implementation of withdrawal management services pursuant to Minnesota
Statutes, section 245F.21;
new text end

new text begin (6) primary prevention services to delay onset of substance use and avoid the
development of addiction;
new text end

new text begin (7) development or modification of services to meet the needs of youth and
adolescents and increase student access to substance use disorder services in educational
settings;
new text end

new text begin (8) development of other new services and supports that are responsive to the
chronic nature of substance use disorders; and
new text end

new text begin (9) available options to allow for exceptions to the federal Institution for Mental
Disease (IMD) exclusion for medically necessary, rehabilitative, substance use disorder
treatment provided in the most integrated and least restrictive setting.
new text end

new text begin (b) The commissioner shall seek all federal authority necessary to implement the
proposal. The commissioner shall seek any federal waivers, state plan amendments,
requests for new funding, realignment of existing funding, and other authority necessary
to implement elements of the reform proposal outlined in this section.
new text end

new text begin (c) Implementation is contingent upon legislative approval of the proposal under
this subdivision.
new text end

new text begin Subd. 4. new text end

new text begin Legislative update. new text end

new text begin By February 1, 2017, the commissioner shall present
an update on the progress of the proposal to members of the legislative committees of the
house of representatives and senate with jurisdiction over health and human services
policy and finance on the progress of the proposal and shall make recommendations on
legislative changes and state appropriations necessary to implement the proposal.
new text end

new text begin Subd. 5. new text end

new text begin Stakeholder input. new text end

new text begin In developing the proposal, the commissioner shall
consult with stakeholders, including consumers, providers, counties, tribes, and health
plans.
new text end

ARTICLE 3

MISCELLANEOUS

Section 1.

Minnesota Statutes 2015 Supplement, section 125A.08, is amended to read:


125A.08 INDIVIDUALIZED EDUCATION PROGRAMS.

(a) At the beginning of each school year, each school district shall have in effect, for
each child with a disability, an individualized education program.

(b) As defined in this section, every district must ensure the following:

(1) all students with disabilities are provided the special instruction and services
which are appropriate to their needs. Where the individualized education program team
has determined appropriate goals and objectives based on the student's needs, including
the extent to which the student can be included in the least restrictive environment,
and where there are essentially equivalent and effective instruction, related services, or
assistive technology devices available to meet the student's needs, cost to the district may
be among the factors considered by the team in choosing how to provide the appropriate
services, instruction, or devices that are to be made part of the student's individualized
education program. The individualized education program team shall consider and
may authorize services covered by medical assistance according to section 256B.0625,
subdivision 26
. new text beginBefore a school district evaluation team makes a determination of other
health disability under Minnesota Rules, part 3525.1335, subparts 1 and 2, item A, subitem
(1), the evaluation team must seek written documentation of the student's medically
diagnosed chronic or acute health condition signed by a licensed physician or a licensed
health care provider acting within the scope of the provider's practice.
new text endThe student's
needs and the special education instruction and services to be provided must be agreed
upon through the development of an individualized education program. The program
must address the student's need to develop skills to live and work as independently
as possible within the community. The individualized education program team must
consider positive behavioral interventions, strategies, and supports that address behavior
needs for children. During grade 9, the program must address the student's needs for
transition from secondary services to postsecondary education and training, employment,
community participation, recreation, and leisure and home living. In developing the
program, districts must inform parents of the full range of transitional goals and related
services that should be considered. The program must include a statement of the needed
transition services, including a statement of the interagency responsibilities or linkages or
both before secondary services are concluded;

(2) children with a disability under age five and their families are provided special
instruction and services appropriate to the child's level of functioning and needs;

(3) children with a disability and their parents or guardians are guaranteed procedural
safeguards and the right to participate in decisions involving identification, assessment
including assistive technology assessment, and educational placement of children with a
disability;

(4) eligibility and needs of children with a disability are determined by an initial
evaluation or reevaluation, which may be completed using existing data under United
States Code, title 20, section 33, et seq.;

(5) to the maximum extent appropriate, children with a disability, including those
in public or private institutions or other care facilities, are educated with children who
are not disabled, and that special classes, separate schooling, or other removal of children
with a disability from the regular educational environment occurs only when and to the
extent that the nature or severity of the disability is such that education in regular classes
with the use of supplementary services cannot be achieved satisfactorily;

(6) in accordance with recognized professional standards, testing and evaluation
materials, and procedures used for the purposes of classification and placement of children
with a disability are selected and administered so as not to be racially or culturally
discriminatory; and

(7) the rights of the child are protected when the parents or guardians are not known
or not available, or the child is a ward of the state.

(c) For all paraprofessionals employed to work in programs whose role in part is
to provide direct support to students with disabilities, the school board in each district
shall ensure that:

(1) before or beginning at the time of employment, each paraprofessional must
develop sufficient knowledge and skills in emergency procedures, building orientation,
roles and responsibilities, confidentiality, vulnerability, and reportability, among other
things, to begin meeting the needs, especially disability-specific and behavioral needs, of
the students with whom the paraprofessional works;

(2) annual training opportunities are required to enable the paraprofessional to
continue to further develop the knowledge and skills that are specific to the students with
whom the paraprofessional works, including understanding disabilities, the unique and
individual needs of each student according to the student's disability and how the disability
affects the student's education and behavior, following lesson plans, and implementing
follow-up instructional procedures and activities; and

(3) a districtwide process obligates each paraprofessional to work under the ongoing
direction of a licensed teacher and, where appropriate and possible, the supervision of a
school nurse.

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

Minnesota Statutes 2014, section 148.975, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this
section.

(b) "Other person" means an immediate family member or someone who personally
knows the client and has reason to believe the client is capable of and will carry out the
serious, specific threat of harm to a specific, clearly identified or identifiable victim.

(c) "Reasonable efforts" means communicating the serious, specific threat to the
potential victim and if unable to make contact with the potential victim, communicating
the serious, specific threat to the law enforcement agency closest to the potential victim or
the client.

new text begin (d) For purposes of this section, "licensee" includes practicum psychology students,
predoctoral psychology interns, and individuals who have earned a doctoral degree
in psychology and are in the process of completing their postdoctoral supervised
psychological employment in order to qualify for licensure.
new text end

Sec. 3.

Minnesota Statutes 2014, section 148B.1751, is amended to read:


148B.1751 DUTY TO WARN.

new text begin (a) new text endA licensee must comply with the duty to warn established in section 148.975.

new text begin (b) For purposes of this section, "licensee" includes students or interns practicing
marriage and family therapy under qualified supervision as part of an accredited
educational program or under a supervised postgraduate experience in marriage and
family therapy required for licensure.
new text end

Sec. 4.

Minnesota Statutes 2014, section 148F.13, subdivision 2, is amended to read:


Subd. 2.

Duty to warn; limitation on liability.

new text begin (a) new text endPrivate information may be
disclosed without the consent of the client when a duty to warn arises, or as otherwise
provided by law or court order. The duty to warn of, or take reasonable precautions to
provide protection from, violent behavior arises only when a client or other person has
communicated to the provider a specific, serious threat of physical violence to self or a
specific, clearly identified or identifiable potential victim. If a duty to warn arises, the duty
is discharged by the provider if reasonable efforts are made to communicate the threat to
law enforcement agencies, the potential victim, the family of the client, or appropriate
third parties who are in a position to prevent or avert the harm. No monetary liability
and no cause of action or disciplinary action by the board may arise against a provider
for disclosure of confidences to third parties, for failure to disclose confidences to third
parties, or for erroneous disclosure of confidences to third parties in a good faith effort to
warn against or take precautions against a client's violent behavior or threat of suicide.

new text begin (b) For purposes of this subdivision, "provider" includes alcohol and drug counseling
practicum students and individuals who are participating in a postdegree professional
practice in alcohol and drug counseling.
new text end

Sec. 5.

Minnesota Statutes 2014, section 245A.11, subdivision 2a, is amended to read:


Subd. 2a.

Adult foster care and community residential setting license capacity.

(a) The commissioner shall issue adult foster care and community residential setting
licenses with a maximum licensed capacity of four beds, including nonstaff roomers and
boarders, except that the commissioner may issue a license with a capacity of five beds,
including roomers and boarders, according to paragraphs (b) to (f).

(b) The license holder may have a maximum license capacity of five if all persons
in care are age 55 or over and do not have a serious and persistent mental illness or a
developmental disability.

(c) The commissioner may grant variances to paragraph (b) to allow a facility with a
licensed capacity of new text beginup to new text endfive persons to admit an individual under the age of 55 if the
variance complies with section 245A.04, subdivision 9, and approval of the variance is
recommended by the county in which the licensed facility is located.

(d) The commissioner may grant variances to paragraph (b) to allow the use of
deleted text begina fifthdeleted text endnew text begin an additionalnew text end bednew text begin, up to five,new text end for emergency crisis services for a person with
serious and persistent mental illness or a developmental disability, regardless of age, if the
variance complies with section 245A.04, subdivision 9, and approval of the variance is
recommended by the county in which the licensed facility is located.

(e) The commissioner may grant a variance to paragraph (b) to allow for the use of
deleted text begina fifthdeleted text endnew text begin an additionalnew text end bednew text begin, up to five,new text end for respite services, as defined in section 245A.02,
for persons with disabilities, regardless of age, if the variance complies with sections
245A.03, subdivision 7, and 245A.04, subdivision 9, and approval of the variance is
recommended by the county in which the licensed facility is located. Respite care may be
provided under the following conditions:

(1) staffing ratios cannot be reduced below the approved level for the individuals
being served in the home on a permanent basis;

(2) no more than two different individuals can be accepted for respite services in
any calendar month and the total respite days may not exceed 120 days per program in
any calendar year;

(3) the person receiving respite services must have his or her own bedroom, which
could be used for alternative purposes when not used as a respite bedroom, and cannot be
the room of another person who lives in the facility; and

(4) individuals living in the facility must be notified when the variance is approved.
The provider must give 60 days' notice in writing to the residents and their legal
representatives prior to accepting the first respite placement. Notice must be given to
residents at least two days prior to service initiation, or as soon as the license holder is
able if they receive notice of the need for respite less than two days prior to initiation,
each time a respite client will be served, unless the requirement for this notice is waived
by the resident or legal guardian.

(f) The commissioner may issue an adult foster care or community residential setting
license with a capacity of five adults if the fifth bed does not increase the overall statewide
capacity of licensed adult foster care or community residential setting beds in homes that
are not the primary residence of the license holder, as identified in a plan submitted to the
commissioner by the county, when the capacity is recommended by the county licensing
agency of the county in which the facility is located and if the recommendation verifies that:

(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;

(2) the five-bed living arrangement is specified for each resident in the resident's:

(i) individualized plan of care;

(ii) individual service plan under section 256B.092, subdivision 1b, if required; or

(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;

(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice
to remain living in the home and that the resident's refusal to consent would not have
resulted in service termination; and

(4) the facility was licensed for adult foster care before March 1, 2011.

(g) The commissioner shall not issue a new adult foster care license under paragraph
(f) after June 30, deleted text begin2016deleted text endnew text begin 2019new text end. The commissioner shall allow a facility with an adult foster
care license issued under paragraph (f) before June 30, deleted text begin2016deleted text endnew text begin 2019new text end, to continue with a
capacity of five adults if the license holder continues to comply with the requirements in
paragraph (f).

new text begin EFFECTIVE DATE. new text end

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

Sec. 6.

Minnesota Statutes 2015 Supplement, section 256.01, subdivision 12a, is
amended to read:


Subd. 12a.

Department of Human Services child fatality and near fatality
review team.

new text begin(a) new text endThe commissioner shall establish a Department of Human Services
child fatality and near fatality review team to review child fatalities and near fatalities
due to child maltreatment and child fatalities and near fatalities that occur in licensed
facilities and are not due to natural causes. The review team shall assess the entire child
protection services process from the point of a mandated reporter reporting the alleged
maltreatment through the ongoing case management process. Department staff shall lead
and conduct on-site local reviews and utilize supervisors from local county and tribal child
welfare agencies as peer reviewers. The review process must focus on critical elements of
the case and on the involvement of the child and family with the county or tribal child
welfare agency. The review team shall identify necessary program improvement planning
to address any practice issues identified and training and technical assistance needs of
the local agency. Summary reports of each review shall be provided to the state child
mortality review panel when completed.

new text begin (b) A member of the child fatality and near fatality review team shall not disclose
what transpired during the review, except to carry out the duties of the child fatality and
near fatality review team. The proceedings and records of the child fatality and near
fatality review team are protected nonpublic data as defined in section 13.02, subdivision
13, and are not subject to discovery or introduction into evidence in a civil or criminal
action against a professional, the state, or a county agency arising out of the matters the
team is reviewing. Information, documents, and records otherwise available from other
sources are not immune from discovery or use in a civil or criminal action solely because
they were assessed or presented during proceedings of the review team. A person who
presented information before the review team or who is a member of the team shall not
be prevented from testifying about matters within the person's knowledge. In a civil or
criminal proceeding a person shall not be questioned about the person's presentation of
information to the review team or opinions formed by the person as a result of the review.
new text end

Sec. 7.

Minnesota Statutes 2014, section 256B.0751, subdivision 3, is amended to read:


Subd. 3.

Requirements for clinicians certified as health care homes.

(a) A
personal clinician or a primary care clinic may be certified as a health care home. If a
primary care clinic is certified, all of the primary care clinic's clinicians must meet the
criteria of a health care home. In order to be certified as a health care home, a clinician or
clinic must meet the standards set by the commissioners in accordance with this section.
Certification as a health care home is voluntary. In order to maintain their status as health
care homes, clinicians or clinics must renew their certification deleted text beginannuallydeleted text endnew text begin every three yearsnew text end.

(b) Clinicians or clinics certified as health care homes must offer their health care
home services to all their patients with complex or chronic health conditions who are
interested in participation.

(c) Health care homes must participate in the health care home collaborative
established under subdivision 5.

Sec. 8.

Minnesota Statutes 2015 Supplement, section 256B.0911, subdivision 3a,
is amended to read:


Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 20
calendar days after the date on which an assessment was requested or recommended.
Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
applies to an assessment of a person requesting personal care assistance services and home
care nursing. The commissioner shall provide at least a 90-day notice to lead agencies
prior to the effective date of this requirement. Face-to-face assessments must be conducted
according to paragraphs (b) to (i).

(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use
certified assessors to conduct the assessment. For a person with complex health care
needs, a public health or registered nurse from the team must be consulted.

(c) The MnCHOICES assessment provided by the commissioner to lead agencies
must be used to complete a comprehensive, person-centered assessment. The assessment
must include the health, psychological, functional, environmental, and social needs of the
individual necessary to develop a community support plan that meets the individual's
needs and preferences.

(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representativedeleted text begin, and other individuals as requested by
the person, who can provide information on the needs, strengths, and preferences of the
person necessary to develop a community support plan that ensures the person's health and
safety, but who is not a provider of service or has any financial interest in the provision of
services
deleted text end.new text begin At the request of the person, other individuals may participate in the assessment
to provide information on the needs, strengths, and preferences of the person necessary
to develop a community support plan that ensures the person's health and safety. Except
for legal representatives or family members invited by the person, persons participating
in the assessment may not be a provider of service or have any financial interest in the
provision of services.
new text end For persons who are to be assessed for elderly waiver customized
living services under section 256B.0915, with the permission of the person being assessed
or the person's designated or legal representative, the client's current or proposed provider
of services may submit a copy of the provider's nursing assessment or written report
outlining its recommendations regarding the client's care needs. The person conducting
the assessment must notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
prior to the assessment. For a person who is to be assessed for waiver services under
section 256B.092 or 256B.49, with the permission of the person being assessed or the
person's designated legal representative, the person's current provider of services may
submit a written report outlining recommendations regarding the person's care needs
prepared by a direct service employee with at least 20 hours of service to that client. The
person conducting the assessment or reassessment must notify the provider of the date
by which this information is to be submitted. This information shall be provided to the
person conducting the assessment and the person or the person's legal representative, and
must be considered prior to the finalization of the assessment or reassessment.

(e) The person or the person's legal representative must be provided with a written
community support plan within 40 calendar days of the assessment visit, regardless
of whether the individual is eligible for Minnesota health care programs. The written
community support plan must include:

(1) a summary of assessed needs as defined in paragraphs (c) and (d);

(2) the individual's options and choices to meet identified needs, including all
available options for case management services and providers;

(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;

(4) referral information; and

(5) informal caregiver supports, if applicable.

For a person determined eligible for state plan home care under subdivision 1a,
paragraph (b), clause (1), the person or person's representative must also receive a copy of
the home care service plan developed by the certified assessor.

(f) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying
community support, the person must be transferred or referred to long-term care options
counseling services available under sections 256.975, subdivision 7, and 256.01,
subdivision 24, for telephone assistance and follow up.

(g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in section 256.975, subdivision 7a, paragraph (d).

(h) The lead agency must give the person receiving assessment or support planning,
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) written recommendations for community-based services and consumer-directed
options;

(2) documentation that the most cost-effective alternatives available were offered to
the individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;

(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;

(4) the role of long-term care consultation assessment and support planning in
eligibility determination for waiver and alternative care programs, and state plan home
care, case management, and other services as defined in subdivision 1a, paragraphs (a),
clause (6), and (b);

(5) information about Minnesota health care programs;

(6) the person's freedom to accept or reject the recommendations of the team;

(7) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;

(8) the certified assessor's decision regarding the person's need for institutional
level of care as determined under criteria established in subdivision 4e and the certified
assessor's decision regarding eligibility for all services and programs as defined in
subdivision 1a, paragraphs (a), clause (6), and (b); and

(9) the person's right to appeal the certified assessor's decision regarding eligibility
for all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7),
and (8), and (b), and incorporating the decision regarding the need for institutional level of
care or the lead agency's final decisions regarding public programs eligibility according to
section 256.045, subdivision 3.

(i) Face-to-face assessment completed as part of eligibility determination for the
alternative care, elderly waiver, community access for disability inclusion, community
alternative care, and brain injury waiver programs under sections 256B.0913, 256B.0915,
and 256B.49 is valid to establish service eligibility for no more than 60 calendar days
after the date of assessment.

(j) The effective eligibility start date for programs in paragraph (i) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before
the effective waiver or alternative care program eligibility start date, assessment and
support plan information must be updated and documented in the department's Medicaid
Management Information System (MMIS). Notwithstanding retroactive medical assistance
coverage of state plan services, the effective date of eligibility for programs included in
paragraph (i) cannot be prior to the date the most recent updated assessment is completed.

Sec. 9.

Minnesota Statutes 2015 Supplement, section 256B.766, is amended to read:


256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

(a) Effective for services provided on or after July 1, 2009, total payments for basic
care services, shall be reduced by three percent, except that for the period July 1, 2009,
through June 30, 2011, total payments shall be reduced by 4.5 percent for the medical
assistance and general assistance medical care programs, prior to third-party liability and
spenddown calculation. Effective July 1, 2010, the commissioner shall classify physical
therapy services, occupational therapy services, and speech-language pathology and
related services as basic care services. The reduction in this paragraph shall apply to
physical therapy services, occupational therapy services, and speech-language pathology
and related services provided on or after July 1, 2010.

(b) Payments made to managed care plans and county-based purchasing plans shall
be reduced for services provided on or after October 1, 2009, to reflect the reduction
effective July 1, 2009, and payments made to the plans shall be reduced effective October
1, 2010, to reflect the reduction effective July 1, 2010.

(c) Effective for services provided on or after September 1, 2011, through June 30,
2013, total payments for outpatient hospital facility fees shall be reduced by five percent
from the rates in effect on August 31, 2011.

(d) Effective for services provided on or after September 1, 2011, through June
30, 2013, total payments for ambulatory surgery centers facility fees, medical supplies
and durable medical equipment not subject to a volume purchase contract, prosthetics
and orthotics, renal dialysis services, laboratory services, public health nursing services,
physical therapy services, occupational therapy services, speech therapy services,
eyeglasses not subject to a volume purchase contract, hearing aids not subject to a volume
purchase contract, and anesthesia services shall be reduced by three percent from the
rates in effect on August 31, 2011.

(e) Effective for services provided on or after September 1, 2014, payments
for ambulatory surgery centers facility fees, hospice services, renal dialysis services,
laboratory services, public health nursing services, eyeglasses not subject to a volume
purchase contract, and hearing aids not subject to a volume purchase contract shall be
increased by three percent and payments for outpatient hospital facility fees shall be
increased by three percent. Payments made to managed care plans and county-based
purchasing plans shall not be adjusted to reflect payments under this paragraph.

(f) Payments for medical supplies and durable medical equipment not subject to a
volume purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014,
through June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies
and durable medical equipment not subject to a volume purchase contract, and prosthetics
and orthotics, provided on or after July 1, 2015, shall be increased by three percent from
the rates as determined under deleted text beginparagraph (i)deleted text endnew text begin paragraphs (i) and (j)new text end.

(g) Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics and orthotics, and laboratory services to a hospital
meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4),
shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments made
to managed care plans and county-based purchasing plans shall not be adjusted to reflect
payments under this paragraph.

(h) This section does not apply to physician and professional services, inpatient
hospital services, family planning services, mental health services, dental services,
prescription drugs, medical transportation, federally qualified health centers, rural health
centers, Indian health services, and Medicare cost-sharing.

(i) Effectivenew text begin for services provided on or afternew text end July 1, 2015, the deleted text beginmedical assistance
payment rate for durable medical equipment, prosthetics, orthotics, or supplies shall
be restored to the January 1, 2008, medical assistance fee schedule, updated to include
subsequent rate increases in the Medicare and medical assistance fee schedules, and
including
deleted text endnew text begin following categories of durable medical equipment shall benew text end individually priced
items deleted text beginfor the following categoriesdeleted text end: enteral nutrition and supplies, customized and other
specialized tracheostomy tubes and supplies, electric patient lifts, and durable medical
equipment repair and service. This paragraph does not apply to medical supplies and
durable medical equipment subject to a volume purchase contract, products subject to the
preferred diabetic testing supply program, and items provided to dually eligible recipients
when Medicare is the primary payer for the item.new text begin The commissioner shall not apply any
medical assistance rate reductions to durable medical equipment as a result of Medicare
competitive bidding.
new text end

new text begin (j) Effective for services provided on or after July 1, 2015, medical assistance
payment rates for durable medical equipment, prosthetics, orthotics, or supplies shall
be increased as follows:
new text end

new text begin (1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies
that were subject to the Medicare competitive bid that took effect in January of 2009 shall
be increased by 9.5 percent; and
new text end

new text begin (2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies
on the medical assistance fee schedule, whether or not subject to the Medicare competitive
bid that took effect in January of 2009, shall be increased by 2.94 percent, with this
increase being applied after calculation of any increased payment rate under clause (1).
new text end

new text begin This paragraph does not apply to medical supplies and durable medical equipment subject
to a volume purchase contract, products subject to the preferred diabetic testing supply
program, items provided to dually eligible recipients when Medicare is the primary payer
for the item, and individually priced items identified in paragraph (i). Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect the
rate increases in this paragraph.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from July 1, 2015.
new text end

Sec. 10.

Minnesota Statutes 2015 Supplement, section 256I.04, subdivision 2a, is
amended to read:


Subd. 2a.

License required; staffing qualifications.

(a) Except as provided in
paragraph (b), an agency may not enter into an agreement with an establishment to provide
group residential housing unless:

(1) the establishment is licensed by the Department of Health as a hotel and restaurant;
a board and lodging establishment; a boarding care home before March 1, 1985; or a
supervised living facility, and the service provider for residents of the facility is licensed
under chapter 245A. However, an establishment licensed by the Department of Health to
provide lodging need not also be licensed to provide board if meals are being supplied to
residents under a contract with a food vendor who is licensed by the Department of Health;

(2) the residence is: (i) licensed by the commissioner of human services under
Minnesota Rules, parts 9555.5050 to 9555.6265; (ii) certified by a county human services
agency prior to July 1, 1992, using the standards under Minnesota Rules, parts 9555.5050
to 9555.6265; (iii) licensed by the commissioner under Minnesota Rules, parts 2960.0010
to 2960.0120, with a variance under section 245A.04, subdivision 9; or (iv) licensed under
section 245D.02, subdivision 4a, as a community residential setting by the commissioner
of human services; or

(3) the establishment is registered under chapter 144D and provides three meals a day.

(b) The requirements under paragraph (a) do not apply to establishments exempt
from state licensure because they are:

(1) located on Indian reservations and subject to tribal health and safety
requirements; or

(2) a supportive housing establishment that has an approved habitability inspection
and an individual lease agreement and that serves people who have experienced long-term
homelessness and were referred through a coordinated assessment in section 256I.03,
subdivision 15.

(c) Supportive housing establishments and emergency shelters must participate in
the homeless management information system.

(d) Effective July 1, 2016, an agency shall not have an agreement with a provider
of group residential housing or supplementary services unless all staff members who
have direct contact with recipients:

(1) have skills and knowledge acquired through one or more of the following:

(i) a course of study in a health- or human services-related field leading to a bachelor
of arts, bachelor of science, or associate's degree;

(ii) one year of experience with the target population served;

(iii) experience as a new text beginmental health new text endcertified peer specialist according to section
256B.0615; or

(iv) meeting the requirements for unlicensed personnel under sections 144A.43
to 144A.483;

(2) hold a current deleted text beginMinnesotadeleted text end driver's license appropriate to the vehicle driven
if transporting recipients;

(3) complete training on vulnerable adults mandated reporting and child
maltreatment mandated reporting, where applicable; and

(4) complete group residential housing orientation training offered by the
commissioner.

new text begin EFFECTIVE DATE. new text end

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

Sec. 11.

Minnesota Statutes 2015 Supplement, section 402A.18, subdivision 3, is
amended to read:


Subd. 3.

Conditions prior to imposing remedies.

(a) The commissioner
shall notify a county or service delivery authority that it must submit a performance
improvement plan if:

(1) the county or service delivery authority does not meet the minimum performance
threshold for a measure; or

(2) the county or service delivery authority deleted text begindoes not meet the minimum performance
threshold for one or more racial or ethnic subgroup for which there is a statistically valid
population size for three or more measures,
deleted text endnew text begin has a performance disparity for a racial or
ethnic subgroup,
new text end even if the county or service delivery authority met the threshold for the
overall population. new text beginThe council shall make recommendations on performance disparities,
and the commissioner shall make the final determination.
new text end

deleted text begin The commissioner must approve the performance improvement plan. The county or
deleted text end deleted text begin service delivery authority may negotiate the terms of the performance improvement plan
deleted text end deleted text begin with the commissioner.
deleted text end

(b) When the department determines that a county or service delivery authority does
not meet the minimum performance threshold for a given measure, the commissioner
must advise the county or service delivery authority that fiscal penalties may result if the
performance does not improve. The department must offer technical assistance to the
county or service delivery authority. Within 30 days of the initial advisement from the
department, the county or service delivery authority may claim and the department may
approve an extenuating circumstance that relieves the county or service delivery authority
of any further remedy. If a county or service delivery authority has a small number of
participants in an essential human services program such that reliable measurement is
not possible, the commissioner may approve extenuating circumstances deleted text beginor may average
performance over three years
deleted text end.

(c) If there are no extenuating circumstances, the county or service delivery authority
must submit a performance improvement plan to the commissioner within 60 days of the
initial advisement from the department. The term of the performance improvement plan
must be two years, starting with the date the plan is approved by the commissioner. This
plan must include a target level for improvement for each measure that did not meet the
minimum performance threshold. The commissioner must approve the performance
improvement plan within 60 days of submittal.

(d) The department must monitor the performance improvement plan for two
years. After two years, if the county or service delivery authority meets the minimum
performance threshold, there is no further remedy. If the county or service delivery
authority fails to meet the minimum performance threshold, but meets the improvement
target in the performance improvement plan, the county or service delivery authority shall
modify the performance improvement plan for further improvement and the department
shall continue to monitor the plan.

(e) If, after two years of monitoring, the county or service delivery authority fails to
meet both the minimum performance threshold and the improvement target identified in
the performance improvement plan, the next step of the remedies process shall be invoked
by the commissioner. This phase of the remedies process may include:

(1) fiscal penalties for the county or service delivery authority that do not exceed
one percent of the county's human services expenditures and that are negotiated in the
performance improvement plan, based on what is needed to improve outcomes. Counties
or service delivery authorities must reinvest the amount of the fiscal penalty into the
essential human services program that was underperforming. A county or service delivery
authority shall not be required to pay more than three fiscal penalties in a year; and

(2) the department's provision of technical assistance to the county or service
delivery authority that is targeted to address the specific performance issues.

The commissioner shall continue monitoring the performance improvement plan for a
third year.

(f) If, after the third year of monitoring, the county or service delivery authority
meets the minimum performance threshold, there is no further remedy. If the county or
service delivery authority fails to meet the minimum performance threshold, but meets the
improvement target for the performance improvement plan, the county or service delivery
authority shall modify the performance improvement plan for further improvement and
the department shall continue to monitor the plan.

(g) If, after the third year of monitoring, the county or service delivery authority fails
to meet the minimum performance threshold and the improvement target identified in the
performance improvement plan, the Human Services Performance Council shall review
the situation and recommend a course of action to the commissioner.

(h) If the commissioner has determined that a program has a balanced set of program
measures and a county or service delivery authority is subject to fiscal penalties for more
than one-half of the measures for that program, the commissioner may apply further
remedies as described in subdivisions 1 and 2.

new text begin EFFECTIVE DATE. new text end

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

Sec. 12. new text beginACTION PLAN TO INCREASE COMMUNITY INTEGRATION OF
PEOPLE WITH DISABILITIES.
new text end

new text begin The commissioners of human services, education, the Minnesota Housing Finance
Agency, employment and economic development, and information technology, in
consultation with stakeholders, including lead agencies, shall develop a collaborative
action plan in alignment with the state's Olmstead Plan to increase the community
integration of people with disabilities, including housing, community living, and
competitive employment. Priority must be given to actions that align policies and funding,
streamline access to services, and increase efficiencies in interagency collaboration.
Recommendations must include a proposed method to allow people with disabilities who
access services from the state agencies identified in this section to access a unified record
of the services they receive, using existing methods for unified records, where appropriate.
This method must also allow people with disabilities to efficiently provide information to
multiple agencies regarding service choices and preferences. Recommendations must be
provided to the legislature by January 1, 2017, and include proposed statutory changes,
including any changes necessary to the data practices act to allow for data sharing, and
information technology solutions required to implement the actions.
new text end

Sec. 13. new text beginHOUSING SUPPORT SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Comprehensive housing support services. new text end

new text begin The commissioner shall
design comprehensive housing services to support an individual's ability to obtain or
maintain stable housing.
new text end

new text begin Subd. 2. new text end

new text begin Goals. new text end

new text begin The proposal required in subdivision 3 shall support the following
goals:
new text end

new text begin (1) improve housing stability;
new text end

new text begin (2) increase opportunities for integrated community living;
new text end

new text begin (3) prevent and reduce homelessness
new text end

new text begin (4) increase overall health and well-being of people with housing instability; and
new text end

new text begin (5) reduce inefficient use of health care that may result from housing instability.
new text end

new text begin Subd. 3. new text end

new text begin Housing support services benefit set proposal. new text end

new text begin (a) The commissioner
shall develop a proposal for housing support services, including, but not limited to, the
following components:
new text end

new text begin (1) housing transition services that include, but are not limited to, tenant screening
and housing assessment; developing an individualized housing support plan; assisting with
housing search and application process; identifying resources to cover onetime moving
expenses; ensuring new living environment is safe and ready for move-in; assisting in
arranging for and supporting details of the move; developing a housing support crisis plan;
and payment for accessibility modifications to new housing; and
new text end

new text begin (2) housing and tenancy sustaining services that include, but are not limited to,
prevention and early identification of behaviors that may jeopardize continued housing;
training on the roles, rights, and responsibilities of tenant and landlord; coaching to
develop and maintain key relationships with landlords and property managers; advocacy
and linkage with community resources to prevent eviction when housing is at risk;
assistance with housing recertification processes; coordination with tenant to review;
update and modify housing support and crisis plan on a regular basis; and continuing
training on tenant responsibilities, lease compliance, or household management.
new text end

new text begin (b) The commissioner shall seek all federal authority and funding necessary to
implement the proposal.
new text end

new text begin (c) Implementation is contingent upon legislative approval of the proposal under
this subdivision.
new text end

new text begin Subd. 4. new text end

new text begin Legislative update. new text end

new text begin By February 1, 2017, the commissioner shall present
an update on the progress of the proposal to members of the legislative committees in the
house of representatives and senate with jurisdiction over health and human services
policy and finance on the progress of the proposal and shall make recommendations on
statutory changes and state appropriations necessary to implement the proposal.
new text end

new text begin Subd. 5. new text end

new text begin Stakeholder input. new text end

new text begin In developing the proposal, the commissioner shall
consult with stakeholders, including people who may utilize the service, advocates,
providers, counties, tribes, health plans, and landlords.
new text end

ARTICLE 4

MINNESOTA ELIGIBILITY SYSTEM EXECUTIVE STEERING COMMITTEE

Section 1.

Minnesota Statutes 2015 Supplement, section 62V.03, subdivision 2, is
amended to read:


Subd. 2.

Application of other law.

(a) MNsure must be reviewed by the legislative
auditor under section 3.971. The legislative auditor shall audit the books, accounts, and
affairs of MNsure once each year or less frequently as the legislative auditor's funds and
personnel permit. Upon the audit of the financial accounts and affairs of MNsure, MNsure
is liable to the state for the total cost and expenses of the audit, including the salaries paid
to the examiners while actually engaged in making the examination. The legislative
auditor may bill MNsure either monthly or at the completion of the audit. All collections
received for the audits must be deposited in the general fund and are appropriated to
the legislative auditor. Pursuant to section 3.97, subdivision 3a, the Legislative Audit
Commission is requested to direct the legislative auditor to report by March 1, 2014, to
the legislature on any duplication of services that occurs within state government as a
result of the creation of MNsure. The legislative auditor may make recommendations on
consolidating or eliminating any services deemed duplicative. The board shall reimburse
the legislative auditor for any costs incurred in the creation of this report.

(b) Board members of MNsure are subject to sections 10A.07 and 10A.09. Board
members and the personnel of MNsure are subject to section 10A.071.

(c) All meetings of the board new text beginand of the Minnesota Eligibility System Executive
Steering Committee established under section 62V.055
new text endshall comply with the open
meeting law in chapter 13D.

(d) The board and the Web site are exempt from chapter 60K. Any employee of
MNsure who sells, solicits, or negotiates insurance to individuals or small employers must
be licensed as an insurance producer under chapter 60K.

(e) Section 3.3005 applies to any federal funds received by MNsure.

(f) A MNsure decision that requires a vote of the board, other than a decision that
applies only to hiring of employees or other internal management of MNsure, is an
"administrative action" under section 10A.01, subdivision 2.

Sec. 2.

new text begin [62V.055] MINNESOTA ELIGIBILITY SYSTEM EXECUTIVE
STEERING COMMITTEE.
new text end

new text begin Subdivision 1. new text end

new text begin Definition; Minnesota eligibility system. new text end

new text begin For purposes of this
section, "Minnesota eligibility system" means the system that supports eligibility
determinations using a modified adjusted gross income methodology for medical
assistance under section 256B.056, subdivision 1a, paragraph (b), clause (1);
MinnesotaCare under chapter 256L; and qualified health plan enrollment under section
62V.05, subdivision 5, paragraph (c).
new text end

new text begin Subd. 2. new text end

new text begin Establishment; committee membership; costs. new text end

new text begin (a) The Minnesota
Eligibility System Executive Steering Committee is established to provide
recommendations to the MNsure board, the commissioner of human services, and the
commissioner of MN.IT services on the governance, administration, and business
operations of the Minnesota eligibility system. The steering committee shall be composed
of:
new text end

new text begin (1) two members appointed by the commissioner of human services;
new text end

new text begin (2) two members appointed by the board;
new text end

new text begin (3) two members appointed jointly by the Association of Minnesota Counties, the
Minnesota Inter-County Association, and the Minnesota Association of County Social
Service Administrators. One member appointed under this clause shall represent counties
within the seven-county metropolitan area, and one member shall represent counties
outside the seven-county metropolitan area; and
new text end

new text begin (4) two nonvoting members appointed by the commissioner of MN.IT services.
new text end

new text begin (b) One member appointed by the commissioner of human services and one member
appointed by the commissioner of MN.IT services shall serve as co-chairpersons for
the steering committee.
new text end

new text begin (c) Steering committee costs must be paid from the budgets of the Department of
Human Services, the Office of MN.IT Services, and MNsure.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin The Minnesota Eligibility System Executive Steering Committee
shall provide recommendations on an overall governance structure for the Minnesota
eligibility system and the ongoing administration and business operations of the Minnesota
eligibility system. The steering committee shall make recommendations on setting system
goals and priorities, allocating the system's resources, making major system decisions,
and tracking total funding and expenditures for the system from all sources. The steering
committee shall also report to the Legislative Oversight Committee on a quarterly basis
on Minnesota eligibility system funding and expenditures, including amounts received
in the most recent quarter by funding source and expenditures made in the most recent
quarter by funding source.
new text end

new text begin Subd. 4. new text end

new text begin Meetings. new text end

new text begin (a) All meetings of the steering committee must:
new text end

new text begin (1) be held in the State Office Building, the Minnesota Senate Building, or when
approved by the Legislative Oversight Committee, another public location with the
capacity to live stream steering committee meetings; and
new text end

new text begin (2) whenever possible, be made available on a Web site for live audio or video
streaming and be archived on a Web site for playback at a later time.
new text end

new text begin (b) The steering committee must:
new text end

new text begin (1) as part of every steering committee meeting, provide the opportunity for oral
and written public testimony and comments on steering committee recommendations
for the governance, administration, and business operations of the Minnesota eligibility
system; and
new text end

new text begin (2) provide documents under discussion or review by the steering committee to be
electronically posted on MNsure's Web site. Documents must be provided and posted
prior to the meeting at which the documents are scheduled for review or discussion.
new text end

new text begin (c) All votes of the steering committee must be recorded, with each member's vote
identified.
new text end

new text begin Subd. 5. new text end

new text begin Administrative structure. new text end

new text begin The Office of MN.IT Services shall be
responsible for the design, build, maintenance, operation, and upgrade of the information
technology for the Minnesota eligibility system. In carrying out its duties, the office shall
consider recommendations made by the steering committee.
new text end

Sec. 3.

Minnesota Statutes 2014, section 62V.11, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Review of Minnesota eligibility system funding and expenditures. new text end

new text begin The
committee shall review quarterly reports submitted by the Minnesota Eligibility System
Executive Steering Committee under section 62V.055, subdivision 3, regarding Minnesota
eligibility system funding and expenditures.
new text end