SF 2499

2nd Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/21/2023 09:12am

A bill for an act
relating to behavioral health; providing and waiving fees for certified birth records,
identification cards, and driver's licenses for persons treated for substance use
disorder who are eligible for medical assistance; modifying substance use disorder
treatment plan review requirements; providing for transition follow-up counseling;
modifying substance use disorder treatment rate and staffing requirements; requiring
data to be provided to substance use disorder treatment providers; providing
temporary rate increases for substance use disorder treatment providers and direct
care staff; directing the commissioner of human services to develop
recommendations on transition support services; requiring a report; amending
Minnesota Statutes 2022, sections 144.226, by adding a subdivision; 171.06, by
adding a subdivision; 245G.06, subdivision 3; 245G.07, by adding a subdivision;
254B.05, subdivision 5; 254B.051; 254B.12, by adding subdivisions; proposing
coding for new law in Minnesota Statutes, chapter 144.

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

Section 1.

new text begin [144.2256] CERTIFIED BIRTH RECORD FOR PERSONS ELIGIBLE
FOR MEDICAL ASSISTANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Application; birth record. new text end

new text begin A subject of a birth record who is medical
assistance eligible according to chapter 256B and who has been treated for a substance use
disorder within the past 12 months may apply to the state registrar or a local issuance office
for a certified birth record according to this section. The state registrar or local issuance
office shall issue a certified birth record, or statement of no vital record found, to a subject
of a birth record who submits:
new text end

new text begin (1) a completed application signed by the subject of the birth record;
new text end

new text begin (2) a statement of eligibility from an employee of a human services agency or a treatment
provider licensed under chapter 245G that receives public funding to provide services to
people with substance use disorders. The statement must verify the subject of the birth
record is medical assistance eligible according to chapter 256B and has been treated for
substance use disorder in the last 12 months. The statement must comply with the
requirements in subdivision 2; and
new text end

new text begin (3) identification in the form of:
new text end

new text begin (i) a document of identity listed in Minnesota Rules, part 4601.2600, subpart 8, or, at
the discretion of the state registrar or local issuance office, Minnesota Rules, part 4601.2600,
subpart 9;
new text end

new text begin (ii) a statement that complies with Minnesota Rules, part 4601.2600, subparts 6 and 7;
or
new text end

new text begin (iii) a statement of identity provided by the employee of a human services agency or a
treatment provider licensed under chapter 245G that receives public funding to provide
services to people with substance use disorders who verified eligibility. The statement must
comply with Minnesota Rules, part 4601.2600, subpart 7.
new text end

new text begin Subd. 2. new text end

new text begin Statement of eligibility. new text end

new text begin A statement of eligibility must be from an employee
of a human services agency or a treatment provider licensed under chapter 245G that receives
public funding to provide services to people with substance use disorders and must verify
the subject of the birth record is medical assistance eligible according to chapter 256B and
has been treated for a substance use disorder within the last 12 months. The statement of
eligibility must include:
new text end

new text begin (1) the employee's first name, middle name, if any, and last name; home or business
address; telephone number, if any; and e-mail address, if any;
new text end

new text begin (2) the name of the human services agency or treatment provider licensed under chapter
245G that receives public funding to provide services to people with substance use disorders
that employs the person making the eligibility statement;
new text end

new text begin (3) the first name, middle name, if any, and last name of the subject of the birth record;
new text end

new text begin (4) a copy of the individual's employment identification, or verification of employment,
linking the employee to the human services agency or treatment provider licensed under
chapter 245G that provided treatment; and
new text end

new text begin (5) a statement specifying the relationship of the individual providing the eligibility
statement to the subject of the birth record.
new text end

new text begin Subd. 3. new text end

new text begin Data practices. new text end

new text begin Data listed under subdivision 1, clauses (2) and (3), are private
data on individuals.
new text end

Sec. 2.

Minnesota Statutes 2022, section 144.226, is amended by adding a subdivision to
read:

new text begin Subd. 9. new text end

new text begin Birth record fees waived for people treated for substance use disorder. new text end

new text begin A
person who applies for a certified birth certificate under section 144.2256 shall not be
charged any of the fees specified in this section for a certified birth record or statement of
no vital record found.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end

Sec. 3.

Minnesota Statutes 2022, section 171.06, is amended by adding a subdivision to
read:

new text begin Subd. 12. new text end

new text begin Application; identification card or copy of driver's license. new text end

new text begin (a) A subject
of an identification card or driver's license who is eligible for medical assistance according
to chapter 256B and who has been treated for a substance use disorder within the last 12
months of application may apply to the commissioner or driver's license agent for an
identification card or driver's license according to this section. The commissioner or driver's
license agent shall issue an identification card or driver's license and waive all fees to a
person who submits:
new text end

new text begin (1) a completed application signed by the subject of the identification card or driver's
license;
new text end

new text begin (2) a statement that the subject of the identification card or driver's license is eligible
for medical assistance according to chapter 256B and has been treated for substance use
disorder in the last 12 months, signed by the subject of the identification card or driver's
license; and
new text end

new text begin (3) a statement verifying that the subject of the identification card or driver's license is
eligible for medical assistance according to chapter 256B and has been treated for substance
use disorder in the last 12 months that complies with the requirements in paragraph (b) and
is from an employee of a human services agency that receives public funding to provide
services to people with substance use disorders.
new text end

new text begin (b) A statement verifying that a subject of an identification card or driver's license is
eligible for medical assistance according to chapter 256B and has been treated for a substance
use disorder within 12 months must include:
new text end

new text begin (1) the following information regarding the individual providing the statement: first
name, middle name, if any, and last name; home or business address; telephone number, if
any; and e-mail address, if any;
new text end

new text begin (2) the first name, middle name, if any, and last name of the subject of the identification
card or driver's license; and
new text end

new text begin (3) a statement specifying the relationship of the individual providing the statement to
the subject of the identification card or driver's license and verifying that the subject of the
identification card or driver's license is eligible for medical assistance according to chapter
256B and has been treated for a substance use disorder within the last 12 months.
new text end

new text begin (c) For identification cards and driver's licenses issued under this section:
new text end

new text begin (1) the commissioner must not impose a fee, surcharge, or filing fee under section 171.06,
subdivision 2; and
new text end

new text begin (2) a driver's license agent must not impose a filing fee under section 171.061, subdivision
4.
new text end

Sec. 4.

Minnesota Statutes 2022, section 245G.06, subdivision 3, is amended to read:

Subd. 3.

Treatment plan review.

A treatment plan review must be entered in a client's
file deleted text begin weekly or after each treatment service, whichever is less frequent, deleted text end by the alcohol and
drug counselor deleted text begin responsible for the client's treatment plan deleted text end new text begin at least every 28 calendar days,
or when there is a significant change in the client's situation, functioning, or service methods,
or at the request of the client new text end . The review must indicate the span of time covered by the
review and each of the six dimensions listed in section 245G.05, subdivision 2, paragraph
(c). The review must:

(1) address each goal in the treatment plan and whether the methods to address the goals
are effective;

(2) include monitoring of any physical and mental health problems;

(3) document the participation of others;

(4) document staff recommendations for changes in the methods identified in the treatment
plan and whether the client agrees with the change; and

(5) include a review and evaluation of the individual abuse prevention plan according
to section 245A.65.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2023.
new text end

Sec. 5.

Minnesota Statutes 2022, section 245G.07, is amended by adding a subdivision to
read:

new text begin Subd. 1a. new text end

new text begin Transition follow-up counseling. new text end

new text begin (a) A client that was discharged from a
treatment center may, pursuant to the client's request, receive individual transition follow-up
counseling from the treatment center from which the client was discharged for up to one
year following the client's discharge. The transition follow-up counseling must be designed
to address the client's needs related to substance use, develop strategies to avoid harmful
substance use after discharge, and help the client obtain the services necessary to establish
or maintain a lifestyle free from the harmful effects of substance use disorder.
new text end

new text begin (b) A provider that provides transition follow-up counseling services under paragraph
(a) may bill for the services described in subdivision 1, paragraph (a), at the same rate as
for individual counseling sessions.
new text end

new text begin (c) In any given month, a client must not exceed four sessions of treatment services
under subdivision 1, paragraph (a), for follow-up counseling under this subdivision.
new text end

new text begin (d) A provider must document in the client's file the services provided under this section.
The treatment provider is not required to conduct a new comprehensive assessment and is
not required to open or reopen a treatment plan or document a review of all treatment services
in a treatment plan review as required by section 245G.06, subdivision 3.
new text end

new text begin (e) Prepaid medical assistance plans under section 256B.69 must allow members to
access follow-up counseling under this subdivision at their discretion.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end

Sec. 6.

Minnesota Statutes 2022, section 254B.05, subdivision 5, is amended to read:

Subd. 5.

Rate requirements.

(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.

(b) Eligible substance use disorder treatment services include:

(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable Tribal license;

(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;

(3) deleted text begin care deleted text end new text begin treatment new text end coordination services provided according to section 245G.07,
subdivision 1, paragraph (a), clause (5);

(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);

(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;

(6) substance use disorder treatment services with medications for opioid use disorder
that are licensed according to sections 245G.01 to 245G.17 and 245G.22, or applicable
Tribal license;

(7) substance use disorder treatment with medications for opioid use disorder plus
enhanced treatment services that meet the requirements of clause (6) and provide nine hours
of clinical services each week;

(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable Tribal license deleted text begin which deleted text end new text begin
that new text end provide, respectively, 30, 15, and five hours of clinical services each new text begin treatment new text end week new text begin .
A license holder that is unable to provide all residential treatment services because a client
missed services remains eligible to bill for the client's intensity level of services under this
clause if the license holder can document the reason the client missed services and the
interventions done to address the client's absence. Hours in a treatment week may be reduced
in observance of federally recognized holidays new text end ;

(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable Tribal license and licensed as a hospital under sections 144.50 to
144.56;

(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable Tribal license;

(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable Tribal license, deleted text begin which deleted text end new text begin that new text end provide 30 hours
of clinical services each week provided by a state-operated vendor or to clients who have
been civilly committed to the commissioner, present the most complex and difficult care
needs, and are a potential threat to the community; and

(12) room and board facilities that meet the requirements of subdivision 1a.

(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:

(1) programs that serve parents with their children if the program:

(i) provides on-site child care during the hours of treatment activity that:

(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or

(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or

(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:

(A) a child care center under Minnesota Rules, chapter 9503; or

(B) a family child care home under Minnesota Rules, chapter 9502;

(2) culturally specific or culturally responsive programs as defined in section 254B.01,
subdivision 4a;

(3) disability responsive programs as defined in section 254B.01, subdivision 4b;

(4) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; or

(5) programs that offer services to individuals with co-occurring mental health and
substance use disorder problems if:

(i) the program meets the co-occurring requirements in section 245G.20;

(ii) new text begin one full-time equivalent or new text end 25 percent new text begin , whichever is less, new text end of the counseling staff are
licensed mental health professionals under section 245I.04, subdivision 2, or are students
or licensing candidates under the supervision of a licensed alcohol and drug counselor
supervisor and mental health professional under section 245I.04, subdivision 2 deleted text begin , except that
no more than 50 percent of the mental health staff may be students or licensing candidates
with time documented to be directly related to provisions of co-occurring services deleted text end ;

(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;

(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;

(v) family education is offered that addresses mental health and substance use disorder
and the interaction between the two; and

(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.

(d) deleted text begin In order deleted text end To be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the substance use disorder facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.

(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).

(f) Subject to federal approval, substance use disorder services that are otherwise covered
as direct face-to-face services may be provided via telehealth as defined in section 256B.0625,
subdivision 3b. The use of telehealth to deliver services must be medically appropriate to
the condition and needs of the person being served. Reimbursement shall be at the same
rates and under the same conditions that would otherwise apply to direct face-to-face services.

(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.

(h) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.

Sec. 7.

Minnesota Statutes 2022, section 254B.051, is amended to read:

254B.051 SUBSTANCE USE DISORDER TREATMENT EFFECTIVENESS.

new text begin Subdivision 1. new text end

new text begin Commissioner to collect additional data. new text end

In addition to the substance
use disorder treatment program performance outcome measures that the commissioner of
human services collects annually from treatment providers, the commissioner shall request
additional data from programs that receive appropriations from the behavioral health fund.
This data deleted text begin shall deleted text end new text begin must new text end include number of client readmissions six months after release from
inpatient treatment, and the cost of treatment per person for each program receiving
behavioral health funds. The commissioner may post this data on the department website.

new text begin Subd. 2. new text end

new text begin Data to be provided. new text end

new text begin All data collected by the commissioner from substance
use disorder treatment providers, including but not limited to claims, the drug and alcohol
abuse normative evaluation system, the utilization management system, the demonstration
project, and cost reporting, must be made available to substance use disorder treatment
providers. The commissioner must provide the data in a format that complies with chapter
13 in an electronic format that permits providers to access all information provided by them
to the commissioner at least annually. The commissioner must provide for a feature in
reporting data to substance use disorder providers that allows them to compare their
performance against other providers. The commissioner must work with substance use
disorder providers to design the reporting system and format of data availability for the
purposes of improving the efficiency and effectiveness of substance use disorder program
services.
new text end

Sec. 8.

Minnesota Statutes 2022, section 254B.12, is amended by adding a subdivision to
read:

new text begin Subd. 5. new text end

new text begin Temporary rate increase. new text end

new text begin (a) Beginning on or before July 1, 2023, the
commissioner must increase the rate for services under sections 254B.05 and 256B.0759,
subdivision 4, by 24 percent. This rate increase remains in effect until the new comprehensive
rate framework under Laws 2021, First Special Session chapter 7, article 17, section 18, for
substance use disorder residential and outpatient services is implemented. By February 1,
2024, and each February 1 thereafter, the commissioner must report to the chairs and ranking
minority members of the legislative committees and divisions with jurisdiction over health
and human services policy and finance the status of the framework implementation.
new text end

new text begin (b) This subdivision expires the day following the implementation of the new
comprehensive rate framework under Laws 2021, First Special Session chapter 7, article
17, section 18. The commissioner of human services must notify the revisor of statutes when
the new comprehensive rate framework is implemented.
new text end

Sec. 9.

Minnesota Statutes 2022, section 254B.12, is amended by adding a subdivision to
read:

new text begin Subd. 6. new text end

new text begin Substance use disorder direct care staff increase. new text end

new text begin (a) At least 33 percent of
the 24 percent rate increase provided for substance use disorder services under subdivision
5, for services provided between July 1, 2023, and the expiration date in subdivision 5,
paragraph (b), must be used to increase compensation-related costs for employees directly
employed by the program on or after July 1, 2023.
new text end

new text begin (b) For the purposes of this subdivision, "compensation-related costs" include:
new text end

new text begin (1) wages and salaries;
new text end

new text begin (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, workers' compensation, and mileage reimbursement;
new text end

new text begin (3) the employer's paid share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and
new text end

new text begin (4) benefits that address direct support professional workforce needs, above and beyond
benefits offered to employees prior to July 1, 2023, including retention and recruitment
bonuses and tuition reimbursement.
new text end

new text begin (c) Compensation-related costs for persons employed in the central office of a corporation
or entity that has an ownership interest in the provider or exercises control over the provider
or for persons paid by the provider under a management contract do not count toward the
33 percent requirement under this subdivision.
new text end

new text begin (d) A provider agency or individual provider that receives a rate subject to the
requirements of this subdivision shall prepare, and upon request submit to the commissioner,
a distribution plan that specifies the amount of money the provider expects to receive that
is subject to the requirements of this subdivision, including how that money was or will be
distributed to increase compensation-related costs for employees. Within 60 days of final
implementation of a rate adjustment subject to the requirements of this subdivision, the
provider must post the distribution plan. The distribution plan must remain posted for at
least six months in an area of the provider's operation to which all direct support professionals
have access.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end

Sec. 10. new text begin DIRECTION TO THE COMMISSIONER; TRANSITION SUPPORT
SERVICES RECOMMENDATIONS.
new text end

new text begin (a) The commissioner of human services, in consultation with stakeholders, must develop
recommendations related to transition support services for persons who have completed a
substance use disorder treatment program according to Minnesota Statutes, section 245G.14,
subdivision 3, that required 15 or more hours of treatment services per week and who receive
medical assistance or services through the behavioral health fund under Minnesota Statutes,
chapter 254.
new text end

new text begin (b) Stakeholders must equitably represent geographic areas of the state and must include
individuals in recovery from substance use disorder and providers from Black, Indigenous,
people of color, or immigrant communities. Stakeholders must include but are not limited
to:
new text end

new text begin (1) the Minnesota Association of Resources for Recovery and Chemical Health;
new text end

new text begin (2) the Minnesota Alliance of Rural Addiction Treatment Providers;
new text end

new text begin (3) the Minnesota Association of Community Mental Health Programs;
new text end

new text begin (4) recovery community organizations; and
new text end

new text begin (5) current and former clients of substance use disorder treatment programs based in
Minnesota.
new text end

new text begin (c) The commissioner must make recommendations on the following transition support
components:
new text end

new text begin (1) funding for recovery safe housing;
new text end

new text begin (2) food support funding for persons not otherwise eligible for food support programs;
new text end

new text begin (3) child care options;
new text end

new text begin (4) transportation services to facilitate attendance at group meetings or other recovery
activities and a person's ability to work and seek employment and to meet needs of daily
living. The commissioner's recommendations on transportation services must consider:
new text end

new text begin (i) for persons well-served by public transit, a monthly public transit pass; or
new text end

new text begin (ii) for persons who are not well-served by public transit or who have access to personal
transportation, recommendations for a stipend for a gas card each month;
new text end

new text begin (5) a duration period of eligibility for transition support services and service coordination,
regardless of public assistance eligibility, and pursuing a federal waiver to allow persons
receiving transition support services to remain eligible for medical assistance for the identified
eligibility period; and
new text end

new text begin (6) eligibility criteria for transition support services.
new text end

new text begin (d) The commissioner's recommendations for funding transition support services must
maximize existing federal and state funding sources for which recipients may be eligible
and may not count federal and state benefits as income for the purposes of qualifying for
public assistance programs.
new text end

new text begin (e) By December 1, 2023, the commissioner must complete and submit a report on the
recommendations required under this section to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance.
new text end