SF 3066

as introduced - 90th Legislature (2017 - 2018) Posted on 03/16/2018 03:03pm

A bill for an act
relating to human services; modifying provisions governing mental health providers;
amending Minnesota Statutes 2016, sections 245.4871, subdivision 4; 256B.0622,
subdivision 7a; 256B.0623, subdivision 5; 256B.0625, by adding a subdivision;
256B.0946, subdivision 1a; Minnesota Statutes 2017 Supplement, sections 245.462,
subdivision 17; 245.4871, subdivision 26; 256B.0943, subdivision 1.

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

Section 1.

Minnesota Statutes 2017 Supplement, section 245.462, subdivision 17, is
amended to read:

Subd. 17.

Mental health practitioner.

(a) "Mental health practitioner" means a person
providing services to persons with mental illness who is qualified in at least one of the
following ways: (1) holds a bachelor's degree in one of the behavioral sciences or related
fields from an accredited college or university and: ways described in paragraphs (b) to (g).

(b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:

(i) (1) has at least 2,000 hours of supervised experience in the delivery of services to
persons with:

(i) mental illness, substance use disorder, or emotional disturbance; or

(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;

(ii) (2) is fluent in the non-English language of the ethnic group to which at least 50
percent of the practitioner's clients belong, completes 40 hours of training in the delivery
of services to persons with mental illness, and receives clinical supervision from a mental
health professional at least once a week until the requirement of 2,000 hours of supervised
experience is met; or

(iii) (3) is working in a day treatment program under section 245.4712, subdivision 2;

or

(4) has completed a practicum or internship that (1) requires direct interaction with
persons served, and (2) is focused on behavioral sciences or related fields.

(c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:

(2) (1) has at least 6,000 4,000 hours of supervised experience in the delivery of services
to persons with:

(i) mental illness, substance use disorder, or emotional disturbance; or

(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or

(2) has at least 2,000 hours of supervised experience in the delivery of services to persons
with:

(i) mental illness or substance use disorder, and receives clinical supervision as required
by applicable statutes and rules from a mental health professional at least once a week until
the requirement of 4,000 hours of supervised experience is met; or

(ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.

(3) (d) For purposes of this subdivision, a practitioner is qualified through a graduate
student internship if the practitioner is a graduate student in one of the behavioral sciences
or related fields and is formally assigned by an accredited college or university to an agency
or facility for clinical training; or.

(e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:

(4) (1) holds a master's or other graduate degree in one of the behavioral sciences or
related fields from an accredited college or university and has less than 4,000 hours
post-master's experience in the treatment of mental illness.; or

(2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (1) requires direct interaction with persons served, and (2) is
focused on behavioral sciences or related fields.

(f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.

(g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:

(1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or

(2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.

(h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).

(i) This subdivision supersedes any other statute or rule.

Sec. 2.

Minnesota Statutes 2016, section 245.4871, subdivision 4, is amended to read:

Subd. 4.

Case management service provider.

(a) "Case management service provider"
means a case manager or case manager associate employed by the county or other entity
authorized by the county board to provide case management services specified in subdivision
3 for the child with severe emotional disturbance and the child's family.

(b) A case manager must:

(1) have experience and training in working with children;

(2) have at least a bachelor's degree in one of the behavioral sciences or a related field
including, but not limited to, social work, psychology, or nursing from an accredited college
or university or meet the requirements of paragraph (d);

(3) have experience and training in identifying and assessing a wide range of children's
needs;

(4) be knowledgeable about local community resources and how to use those resources
for the benefit of children and their families; and

(5) meet the supervision and continuing education requirements of paragraphs (e), (f),
and (g), as applicable.

(c) A case manager may be a member of any professional discipline that is part of the
local system of care for children established by the county board.

(d) A case manager without a bachelor's degree must meet one of the requirements in
clauses (1) to (3):

(1) have three or four years of experience as a case manager associate;

(2) be a registered nurse without a bachelor's degree who has a combination of specialized
training in psychiatry and work experience consisting of community interaction and
involvement or community discharge planning in a mental health setting totaling three years;
or

(3) be a person who qualified as a case manager under the 1998 Department of Human
Services waiver provision and meets the continuing education, supervision, and mentoring
requirements in this section.

(e) A case manager with at least 2,000 hours of supervised experience in the delivery
of mental health services to children must receive regular ongoing supervision and clinical
supervision totaling 38 hours per year, of which at least one hour per month must be clinical
supervision regarding individual service delivery with a case management supervisor. The
other 26 hours of supervision may be provided by a case manager with two years of
experience. Group supervision may not constitute more than one-half of the required
supervision hours.

(f) A case manager without 2,000 hours of supervised experience in the delivery of
mental health services to children with emotional disturbance must:

(1) begin 40 hours of training approved by the commissioner of human services in case
management skills and in the characteristics and needs of children with severe emotional
disturbance before beginning to provide case management services; and

(2) receive clinical supervision regarding individual service delivery from a mental
health professional at least one hour each week until the requirement of 2,000 hours of
experience is met.

(g) A case manager who is not licensed, registered, or certified by a health-related
licensing board must receive 30 hours of continuing education and training in severe
emotional disturbance and mental health services every two years.

(h) Clinical supervision must be documented in the child's record. When the case manager
is not a mental health professional, the county board must provide or contract for needed
clinical supervision.

(i) The county board must ensure that the case manager has the freedom to access and
coordinate the services within the local system of care that are needed by the child.

(j) A case manager associate (CMA) must:

(1) work under the direction of a case manager or case management supervisor;

(2) be at least 21 years of age;

(3) have at least a high school diploma or its equivalent; and

(4) meet one of the following criteria:

(i) have an associate of arts degree in one of the behavioral sciences or human services;

(ii) be a registered nurse without a bachelor's degree;

(iii) have three years of life experience as a primary caregiver to a child with serious
emotional disturbance as defined in subdivision 6 within the previous ten years;

(iv) have 6,000 hours work experience as a nondegreed state hospital technician; or

(v) be a mental health practitioner as defined in subdivision 26, clause (2). has 6,000
hours of supervised work experience in the delivery of mental health services to children
with emotional disturbances; hours worked as a mental health behavioral aid I or II under
section 256B.0943, subdivision 7, may count toward the 6,000 hours of supervised work
experience.

Individuals meeting one of the criteria in items (i) to (iv) may qualify as a case manager
after four years of supervised work experience as a case manager associate. Individuals
meeting the criteria in item (v) may qualify as a case manager after three years of supervised
experience as a case manager associate.

(k) Case manager associates must meet the following supervision, mentoring, and
continuing education requirements;

(1) have 40 hours of preservice training described under paragraph (f), clause (1);

(2) receive at least 40 hours of continuing education in severe emotional disturbance
and mental health service annually; and

(3) receive at least five hours of mentoring per week from a case management mentor.
A "case management mentor" means a qualified, practicing case manager or case management
supervisor who teaches or advises and provides intensive training and clinical supervision
to one or more case manager associates. Mentoring may occur while providing direct services
to consumers in the office or in the field and may be provided to individuals or groups of
case manager associates. At least two mentoring hours per week must be individual and
face-to-face.

(l) A case management supervisor must meet the criteria for a mental health professional
as specified in subdivision 27.

(m) An immigrant who does not have the qualifications specified in this subdivision
may provide case management services to child immigrants with severe emotional
disturbance of the same ethnic group as the immigrant if the person:

(1) is currently enrolled in and is actively pursuing credits toward the completion of a
bachelor's degree in one of the behavioral sciences or related fields at an accredited college
or university;

(2) completes 40 hours of training as specified in this subdivision; and

(3) receives clinical supervision at least once a week until the requirements of obtaining
a bachelor's degree and 2,000 hours of supervised experience are met.

Sec. 3.

Minnesota Statutes 2017 Supplement, section 245.4871, subdivision 26, is amended
to read:

Subd. 26.

Mental health practitioner.

"Mental health practitioner" means a person
providing services to children with emotional disturbances. A mental health practitioner
must have training and experience in working with children. A mental health practitioner
must be qualified in at least one of the following ways: has the meaning given in section
245.462, subdivision 17.

(1) holds a bachelor's degree in one of the behavioral sciences or related fields, including,
but not limited to, social work, psychology, sociology, community counseling, family social
science, child development/child psychology, community mental health, addiction counseling,
counseling/guidance, and special education from an accredited college or university and:

(i) has at least 2,000 hours of supervised experience in the delivery of mental health
services to children with emotional disturbances; or

(ii) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to children with emotional disturbances, and receives clinical supervision from a mental
health professional at least once a week until the requirement of 2,000 hours of supervised
experience is met;

(2) has at least 6,000 hours of supervised experience in the delivery of mental health
services to children with emotional disturbances; hours worked as a mental health behavioral
aide I or II under section 256B.0943, subdivision 7, may be included in the 6,000 hours of
experience;

(3) is a graduate student in one of the behavioral sciences or related fields and is formally
assigned by an accredited college or university to an agency or facility for clinical training;
or

(4) holds a master's or other graduate degree in one of the behavioral sciences or related
fields from an accredited college or university.

Sec. 4.

Minnesota Statutes 2016, section 256B.0622, subdivision 7a, is amended to read:

Subd. 7a.

Assertive community treatment team staff requirements and roles.

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

(1) the team leader:

(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;

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

(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

(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;

(2) the psychiatric care provider:

(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;

(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;

(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;

(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;

(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;

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

(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;

(3) the nursing staff:

(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;

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

(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;

(4) the co-occurring disorder specialist:

(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

(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;

(5) the vocational specialist:

(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;

(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

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

(6) the mental health certified peer specialist:

(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;

(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

(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;

(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

(8) additional staff:

(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;
section 245.462, subdivision 17; a mental health practitioner working as a clinical trainee
according to Minnesota Rules, part 9505.0371, subpart 5, item C; 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

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

(b) Each ACT team must clearly document schedules for all ACT team members.

(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.

(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.

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

Sec. 5.

Minnesota Statutes 2016, section 256B.0623, subdivision 5, is amended to read:

Subd. 5.

Qualifications of provider staff.

(a) Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified under one of the following criteria:

(1) a mental health professional as defined in section 245.462, subdivision 18, clauses
(1) to (6). If the recipient has a current diagnostic assessment by a licensed mental health
professional as defined in section 245.462, subdivision 18, clauses (1) to (6), recommending
receipt of adult mental health rehabilitative services, the definition of mental health
professional for purposes of this section includes a person who is qualified under section
245.462, subdivision 18, clause (7), and who holds a current and valid national certification
as a certified rehabilitation counselor or certified psychosocial rehabilitation practitioner;

(2) a mental health practitioner as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professional;

(3) a certified peer specialist under section 256B.0615. The certified peer specialist must
work under the clinical supervision of a mental health professional; or

(4) a mental health rehabilitation worker. A mental health rehabilitation worker means
a staff person working under the direction of a mental health practitioner or mental health
professional and under the clinical supervision of a mental health professional in the
implementation of rehabilitative mental health services as identified in the recipient's
individual treatment plan who:

(i) is at least 21 years of age;

(ii) has a high school diploma or equivalent;

(iii) has successfully completed 30 hours of training during the two years immediately
prior to the date of hire, or before provision of direct services, in all of the following areas:
recovery from mental illness, mental health de-escalation techniques, recipient rights,
recipient-centered individual treatment planning, behavioral terminology, mental illness,
co-occurring mental illness and substance abuse, psychotropic medications and side effects,
functional assessment, local community resources, adult vulnerability, recipient
confidentiality; and

(iv) meets the qualifications in subitem (A) or (B): paragraph (b).

(b) In addition to the requirements in paragraph (a), a mental health rehabilitation worker
must also meet the qualifications in clause (1), (2), or (3):

(A) has an associate of arts degree or two years full-time postsecondary education in
one of the behavioral sciences or human services; is a registered nurse without a bachelor's
degree; (1) has an associates of arts degree, two years of full-time postsecondary education,
or a total of 15 semester hours or 23 quarter hours in behavioral sciences or related fields,
or who within the previous ten years has:

(1) (i) three years of personal life experience with serious and persistent mental illness;

(2) (ii) three years of life experience as a primary caregiver to an adult with a serious
mental illness or, traumatic brain injury, substance use disorder, or developmental disability;
or

(3) 4,000 (iii) 2,000 hours of supervised paid work experience in the delivery of mental
health services to adults with a serious mental illness or, traumatic brain injury, substance
use disorder, or developmental disability; or

(B)(1) (2)(i) is fluent in the non-English language or competent in the culture of the
ethnic group to which at least 20 percent of the mental health rehabilitation worker's clients
belong;

(2) (ii) receives during the first 2,000 hours of work, monthly documented individual
clinical supervision by a mental health professional;

(3) (iii) has 18 hours of documented field supervision by a mental health professional
or mental health practitioner during the first 160 hours of contact work with recipients, and
at least six hours of field supervision quarterly during the following year;

(4) (iv) has review and cosignature of charting of recipient contacts during field
supervision by a mental health professional or mental health practitioner; and

(5) (v) has 15 hours of additional continuing education on mental health topics during
the first year of employment and 15 hours during every additional year of employment.; or

(3) for providers of crisis residential services, intensive residential treatment services,
partial hospitalization, and day treatment services:

(i) satisfies paragraph (b), clause 2, items (ii) to (iv); and

(ii) has 40 hours of additional continuing education on mental health topics during the
first year of employment.

(c) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is not required to comply with paragraph (a), clause (4), item (iv).

(d) For purposes of this subdivision, "behavioral sciences or related fields" means an
education from an accredited college or university and includes but is not limited to social
work, psychology, sociology, community counseling, family social science, child
development, child psychology, community mental health, addiction counseling, counseling
and guidance, special education, and other fields as approved by the commissioner.

Sec. 6.

Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
to read:

Subd. 65.

Outpatient mental health services.

Medical assistance covers diagnostic
assessment, explanation of findings, and psychotherapy according to Minnesota Rules, part
9505.0372, when the mental health services are performed by a mental health practitioner
working as a clinical trainee according to section 245.462, subdivision 17, paragraph (g).

Sec. 7.

Minnesota Statutes 2017 Supplement, section 256B.0943, subdivision 1, is amended
to read:

Subdivision 1.

Definitions.

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

(a) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.

(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.

(c) "Clinical trainee" means a mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item C.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a. Crisis
assistance entails the development of a written plan to assist a child's family to contend with
a potential crisis and is distinct from the immediate provision of crisis intervention services.

(e) "Culturally competent provider" means a provider who understands and can utilize
to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.

(f) "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a multidisciplinary team, under the clinical supervision of a
mental health professional.

(g) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 9505.0372,
subpart 1.

(h) "Direct service time" means the time that a mental health professional, clinical trainee,
mental health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family or providing covered telemedicine services. Direct service time
includes time in which the provider obtains a client's history, develops a client's treatment
plan, records individual treatment outcomes, or provides service components of children's
therapeutic services and supports. Direct service time does not include time doing work
before and after providing direct services, including scheduling or maintaining clinical
records.

(i) "Direction of mental health behavioral aide" means the activities of a mental health
professional or mental health practitioner in guiding the mental health behavioral aide in
providing services to a client. The direction of a mental health behavioral aide must be based
on the client's individualized treatment plan and meet the requirements in subdivision 6,
paragraph (b), clause (5).

(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision 15.

(k) "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional or mental health practitioner, under the
clinical supervision of a mental health professional, to guide the work of the mental health
behavioral aide. The individual behavioral plan may be incorporated into the child's individual
treatment plan so long as the behavioral plan is separately communicable to the mental
health behavioral aide.

(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part 9505.0371,
subpart 7.

(m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3), to assist a child retain or generalize psychosocial skills as previously
trained by a mental health professional or mental health practitioner and as described in the
child's individual treatment plan and individual behavior plan. Activities involve working
directly with the child or child's family as provided in subdivision 9, paragraph (b), clause
(4).

(n) "Mental health practitioner" means an individual as defined in Minnesota Rules, part
9505.0371, subpart 5, item B, has the meaning given in section 245.462, subdivision 17,
except that a practitioner working in a day treatment setting may be exempt from the
2,000-hour supervised experience requirement in section 245.462, subdivision 17, paragraph
(b), if the day treatment provider delivers 40 hours of training to the practitioner within six
months of employment and the practitioner receives weekly clinical supervision from a
mental health professional until the practitioner meets the 2,000 hours of supervised
experience.

(o) "Mental health professional" means an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18.

(p) "Mental health service plan development" includes:

(1) the development, review, and revision of a child's individual treatment plan, as
provided in Minnesota Rules, part 9505.0371, subpart 7, including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and

(2) administering standardized outcome measurement instruments, determined and
updated by the commissioner, as periodically needed to evaluate the effectiveness of
treatment for children receiving clinical services and reporting outcome measures, as required
by the commissioner.

(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).

(r) "Psychotherapy" means the treatment of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plan.

(s) "Rehabilitative services" or "psychiatric rehabilitation services" means a series or
multidisciplinary combination of psychiatric and psychosocial interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
psychotherapy to address internal psychological, emotional, and intellectual processing
deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.

(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).

Sec. 8.

Minnesota Statutes 2016, section 256B.0946, subdivision 1a, is amended to read:

Subd. 1a.

Definitions.

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

(a) "Clinical care consultation" means communication from a treating clinician to other
providers working with the same client to inform, inquire, and instruct regarding the client's
symptoms, strategies for effective engagement, care and intervention needs, and treatment
expectations across service settings, including but not limited to the client's school, social
services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.

(b) "Clinical supervision" means the documented time a clinical supervisor and supervisee
spend together to discuss the supervisee's work, to review individual client cases, and for
the supervisee's professional development. It includes the documented oversight and
supervision responsibility for planning, implementation, and evaluation of services for a
client's mental health treatment.

(c) "Clinical supervisor" means the mental health professional who is responsible for
clinical supervision.

(d) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371, subpart
5, item C;

(e) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a,
including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis, but does not include actual crisis intervention.

(f) "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370,
subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.

(g) "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.

(h) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 9505.0370,
subpart 11.

(i) "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.

(j) "Foster care" has the meaning given in section 260C.007, subdivision 18.

(k) "Foster family setting" means the foster home in which the license holder resides.

(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part 9505.0370,
subpart 15.

(m) "Mental health practitioner" has the meaning given in Minnesota Rules, part
9505.0370, subpart 17 section 245.462, subdivision 17, and a mental health practitioner
working as a clinical trainee according to Minnesota Rules, part 9505.0371, subpart 5, item
C.

(n) "Mental health professional" has the meaning given in Minnesota Rules, part
9505.0370, subpart 18.

(o) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370, subpart
20.

(p) "Parent" has the meaning given in section 260C.007, subdivision 25.

(q) "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.

(r) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370, subpart
27.

(s) "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.

Sec. 9. INSTRUCTION TO COMMISSIONER.

The commissioner of human services shall amend Minnesota Rules, chapters 9505 and
9520, to conform with the provisions of this act. The commissioner may use the good cause
exemption process under Minnesota Statutes, section 14.388, if applicable, or the expedited
rulemaking process under Minnesota Statutes, section 14.389, in adopting the amendments.