SF 3451

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/19/2024 09:10am

A bill for an act
relating to behavioral health; modifying functional assessment requirements;
exempting children's day treatment providers from medication self-administration
requirements under certain circumstances; modifying certified mental health clinic
staffing standards; modifying intensive residential treatment services and residential
crisis stabilization weekly team meeting requirements; requiring the commissioner
of human services to establish an initial provider entity application and certification
process and recertification process for certain mental health provider types;
modifying client eligibility criteria for certain services in children's therapeutic
services and supports; removing an excluded service from children's therapeutic
services and supports medical assistance payment; modifying intensive
nonresidential rehabilitative mental health services team members to include
co-occurring disorder specialists; amending Minnesota Statutes 2022, sections
245I.10, subdivision 9; 245I.11, subdivision 1; 245I.20, subdivision 4; 245I.23,
subdivision 14; 256B.0943, subdivisions 3, 12; 256B.0947, subdivision 5; proposing
coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2022, section 245I.10, subdivision 9, is amended to read:

Subd. 9.

Functional assessment; required elements.

new text begin (a) new text end When a license holder is
completing a functional assessment for an adult client, the license holder must:

(1) complete a functional assessment of the client after completing the client's diagnostic
assessment;

(2) use a collaborative process that allows the client and the client's family and other
natural supports, the client's referral sources, and the client's providers to provide information
about how the client's symptoms of mental illness impact the client's functioning;

(3) if applicable, document the reasons that the license holder did not contact the client's
family and other natural supports;

(4) assess and document how the client's symptoms of mental illness impact the client's
functioning in the following areas:

(i) the client's mental health symptoms;

(ii) the client's mental health service needs;

(iii) the client's substance use;

(iv) the client's vocational and educational functioning;

(v) the client's social functioning, including the use of leisure time;

(vi) the client's interpersonal functioning, including relationships with the client's family
and other natural supports;

(vii) the client's ability to provide self-care and live independently;

(viii) the client's medical and dental health;

(ix) the client's financial assistance needs; and

(x) the client's housing and transportation needs;

deleted text begin (5) include a narrative summarizing the client's strengths, resources, and all areas of
functional impairment;
deleted text end

deleted text begin (6) deleted text end new text begin (5) new text end complete the client's functional assessment before the client's initial individual
treatment plan unless a service specifies otherwise; and

deleted text begin (7) deleted text end new text begin (6) new text end update the client's functional assessment with the client's current functioning
whenever there is a significant change in the client's functioning or at least every 180 days,
unless a service specifies otherwise.

new text begin (b) A license holder may use any available, validated measurement tool, including but
not limited to the Daily Living Activities-20, when completing the required elements of a
functional assessment under this subdivision.
new text end

Sec. 2.

Minnesota Statutes 2022, section 245I.11, subdivision 1, is amended to read:

Subdivision 1.

Generally.

If a license holder is licensed as a residential program, stores
or administers client medications, or observes clients self-administer medications, the license
holder must ensure that a staff person who is a registered nurse or licensed prescriber is
responsible for overseeing storage and administration of client medications and observing
as a client self-administers medications, including training according to section 245I.05,
subdivision 6, and documenting the occurrence according to section 245I.08, subdivision
5. new text begin A license holder providing children's day treatment services under section 256B.0943 is
exempt from the requirements of this subdivision when serving a child who habitually, as
part of the child's activities of daily life, self-administers medication under the oversight of
the child's prescriber.
new text end

Sec. 3.

Minnesota Statutes 2022, section 245I.20, subdivision 4, is amended to read:

Subd. 4.

Minimum staffing standards.

(a) A certification holder's treatment team must
consist of at least four mental health professionals. At least two of the mental health
professionals must be employed by or under contract with the mental health clinic for a
minimum of 35 hours per week each. deleted text begin Each of the two mental health professionals must
specialize in a different mental health discipline.
deleted text end

(b) The treatment team must include:

(1) a physician qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (4), or a nurse qualified as a mental health professional according to
section 245I.04, subdivision 2, clause (1); and

(2) a psychologist qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (3).

(c) The staff persons fulfilling the requirement in paragraph (b) must provide clinical
services at least:

(1) eight hours every two weeks if the mental health clinic has over 25.0 full-time
equivalent treatment team members;

(2) eight hours each month if the mental health clinic has 15.1 to 25.0 full-time equivalent
treatment team members;

(3) four hours each month if the mental health clinic has 5.1 to 15.0 full-time equivalent
treatment team members; or

(4) two hours each month if the mental health clinic has 2.0 to 5.0 full-time equivalent
treatment team members or only provides in-home services to clients.

(d) The certification holder must maintain a record that demonstrates compliance with
this subdivision.

Sec. 4.

Minnesota Statutes 2022, section 245I.23, subdivision 14, is amended to read:

Subd. 14.

Weekly team meetings.

(a) The license holder must hold weekly new text begin treatment new text end
team meetings deleted text begin and ancillary meetings deleted text end according to this subdivision deleted text begin . deleted text end new text begin and must develop a
plan for communicating reviews of individual treatment plans and individual abuse prevention
plans to any treatment team member who is not present at the meeting but who is scheduled
to work during that calendar week. The communication plan must include:
new text end

new text begin (1) the mode or modes of communication with the treatment team member;
new text end

new text begin (2) how the treatment team member will acknowledge receipt of the communications
and affirm that the team member has reviewed and understands the information
communicated; and
new text end

new text begin (3) instructions for the treatment team member to consult with a mental health
professional or certified rehabilitation specialist if the treatment team member needs further
information.
new text end

(b) A mental health professional or certified rehabilitation specialist must deleted text begin hold deleted text end new text begin supervise new text end
at least one team meeting each calendar week deleted text begin and be physically present at the team meeting deleted text end .
deleted text begin All treatment team members, including treatment team members who work on a part-time
or intermittent basis, must participate in a minimum of one team meeting during each
calendar week when the treatment team member is working for the license holder deleted text end . The
license holder must document all weekly team meetings, including the names of meeting
attendees.

deleted text begin (c) If a treatment team member cannot participate in a weekly team meeting, the treatment
team member must participate in an ancillary meeting. A mental health professional, certified
rehabilitation specialist, clinical trainee, or mental health practitioner who participated in
the most recent weekly team meeting may lead the ancillary meeting. During the ancillary
meeting, the treatment team member leading the ancillary meeting must review the
information that was shared at the most recent weekly team meeting, including revisions
to client treatment plans and other information that the treatment supervisors exchanged
with treatment team members. The license holder must document all ancillary meetings,
including the names of meeting attendees.
deleted text end

Sec. 5.

new text begin [256B.0617] MENTAL HEALTH SERVICES PROVIDER CERTIFICATION.
new text end

new text begin (a) The commissioner of human services shall establish an initial provider entity
application and certification process and recertification process to determine whether a
provider entity has administrative and clinical infrastructures that meet the requirements to
be certified. This process shall apply to providers of the following services:
new text end

new text begin (1) assertive community treatment under section 256B.0622, subdivision 3a;
new text end

new text begin (2) adult rehabilitative mental health services under section 256B.0623;
new text end

new text begin (3) mobile crisis team services under section 256B.0624;
new text end

new text begin (4) children's therapeutic services and supports under section 256B.0943;
new text end

new text begin (5) children's intensive behavioral health services under section 256B.0946; and
new text end

new text begin (6) intensive nonresidential rehabilitative mental health services under section 256B.0947.
new text end

new text begin (b) The commissioner shall recertify a provider entity every three years using the
individual provider's certification anniversary or the calendar year end. The commissioner
may approve a recertification extension in the interest of sustaining services when a certain
date for recertification is identified.
new text end

new text begin (c) The commissioner shall establish a process for decertification of a provider entity
and shall require corrective action, medical assistance repayment, or decertification of a
provider entity 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.
new text end

new text begin (d) The commissioner must provide the following to provider entities for the certification,
recertification, and decertification processes:
new text end

new text begin (1) a structured listing of required provider certification criteria;
new text end

new text begin (2) a formal written letter with a determination of certification, recertification, or
decertification signed by the commissioner or the appropriate division director; and
new text end

new text begin (3) a formal written communication outlining the process for necessary corrective action
and follow-up by the commissioner signed by the commissioner or appropriate division
director, if applicable.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024, and the commissioner of
human services must implement all requirements of this section by September 1, 2024.
new text end

Sec. 6.

Minnesota Statutes 2022, section 256B.0943, subdivision 3, is amended to read:

Subd. 3.

Determination of client eligibility.

new text begin (a) Based on a client's needs identified in
a crisis assessment, a hospital's medical history and presentation examination, or a brief
diagnostic assessment under section 245I.10, subdivision 5, a license holder may provide
a client with any combination of psychotherapy sessions, group psychotherapy sessions,
family psychotherapy sessions, and family psychoeducation sessions. The license holder
shall not provide more than ten sessions within a 12-month period without prior authorization.
new text end

deleted text begin (a) deleted text end new text begin (b) new text end A client's new text begin ongoing new text end eligibility to receive children's therapeutic services and supports
under this section shall be determined based on a standard diagnostic assessment by a mental
health professional or a clinical trainee that is performed within one year before the initial
start of service new text begin and updated as required under section 245I.10, subdivision 2 new text end . The standard
diagnostic assessment must:

(1) determine whether a child under age 18 has a diagnosis of emotional disturbance or,
if the person is between the ages of 18 and 21, whether the person has a mental illness;

(2) document children's therapeutic services and supports as medically necessary to
address an identified disability, functional impairment, and the individual client's needs and
goals; and

(3) be used in the development of the individual treatment plan.

deleted text begin (b) deleted text end new text begin (c) new text end Notwithstanding paragraph deleted text begin (a) deleted text end new text begin (b) new text end , a client may be determined to be eligible for
up to five days of day treatment under this section based on a hospital's medical history and
presentation examination of the client.

deleted text begin (c) deleted text end new text begin (d) new text end Children's therapeutic services and supports include development and rehabilitative
services that support a child's developmental treatment needs.

Sec. 7.

Minnesota Statutes 2022, section 256B.0943, subdivision 12, is amended to read:

Subd. 12.

Excluded services.

The following services are not eligible for medical
assistance payment as children's therapeutic services and supports:

(1) service components of children's therapeutic services and supports simultaneously
provided by more than one provider entity unless prior authorization is obtained;

deleted text begin (2) treatment by multiple providers within the same agency at the same clock time;
deleted text end

deleted text begin (3) deleted text end new text begin (2) new text end children's therapeutic services and supports provided in violation of medical
assistance policy in Minnesota Rules, part 9505.0220;

deleted text begin (4) deleted text end new text begin (3) new text end mental health behavioral aide services provided by a personal care assistant who
is not qualified as a mental health behavioral aide and employed by a certified children's
therapeutic services and supports provider entity;

deleted text begin (5) deleted text end new text begin (4) new text end service components of CTSS that are the responsibility of a residential or program
license holder, including foster care providers under the terms of a service agreement or
administrative rules governing licensure; and

deleted text begin (6) deleted text end new text begin (5) new text end adjunctive activities that may be offered by a provider entity but are not otherwise
covered by medical assistance, including:

(i) a service that is primarily recreation oriented or that is provided in a setting that is
not medically supervised. This includes sports activities, exercise groups, activities such as
craft hours, leisure time, social hours, meal or snack time, trips to community activities,
and tours;

(ii) a social or educational service that does not have or cannot reasonably be expected
to have a therapeutic outcome related to the client's emotional disturbance;

(iii) prevention or education programs provided to the community; and

(iv) treatment for clients with primary diagnoses of alcohol or other drug abuse.

Sec. 8.

Minnesota Statutes 2022, section 256B.0947, subdivision 5, is amended to read:

Subd. 5.

Standards for intensive nonresidential rehabilitative providers.

(a) Services
must meet the standards in this section and chapter 245I as required in section 245I.011,
subdivision 5.

(b) The treatment team must have specialized training in providing services to the specific
age group of youth that the team serves. An individual treatment team must serve youth
who are: (1) at least eight years of age or older and under 16 years of age, or (2) at least 14
years of age or older and under 21 years of age.

(c) The treatment team for intensive nonresidential rehabilitative mental health services
comprises both permanently employed core team members and client-specific team members
as follows:

(1) Based on professional qualifications and client needs, clinically qualified core team
members are assigned on a rotating basis as the client's lead worker to coordinate a client's
care. The core team must comprise at least four full-time equivalent direct care staff and
must minimally include:

(i) a mental health professional who serves as team leader to provide administrative
direction and treatment supervision to the team;

(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;

deleted text begin (iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
deleted text end

deleted text begin (iv) deleted text end new text begin (iii) new text end a mental health certified peer specialist who is qualified according to section
245I.04, subdivision 10, and is also a former children's mental health consumer deleted text begin . deleted text end new text begin ; and
new text end

new text begin (iv) a co-occurring disorder specialist who meets the requirements under section
256B.0622, subdivision 7a, paragraph (a), clause (4), who will provide or facilitate the
provision of co-occurring disorder treatment to clients.
new text end

(2) The core team may also include any of the following:

(i) additional mental health professionals;

(ii) a vocational specialist;

(iii) an educational specialist 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;

(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;

(v) a clinical trainee qualified according to section 245I.04, subdivision 6;

(vi) a mental health practitioner qualified according to section 245I.04, subdivision 4;

(vii) a case management service provider, as defined in section 245.4871, subdivision
4;

(viii) a housing access specialist; and

(ix) a family peer specialist as defined in subdivision 2, paragraph (j).

(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:

(i) the mental health professional treating the client prior to placement with the treatment
team;

(ii) the client's current substance use counselor, if applicable;

(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;

(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;

(v) the client's probation officer or other juvenile justice representative, if applicable;
and

(vi) the client's current vocational or employment counselor, if applicable.

(d) The treatment supervisor shall be an active member of the treatment team and shall
function as a practicing clinician at least on a part-time basis. The treatment team shall meet
with the treatment supervisor at least weekly to discuss recipients' progress and make rapid
adjustments to meet recipients' needs. The team meeting must include client-specific case
reviews and general treatment discussions among team members. Client-specific case
reviews and planning must be documented in the individual client's treatment record.

(e) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.

(f) The treatment team shall serve no more than 80 clients at any one time. Should local
demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.

(g) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitioner, clinical trainee, or mental health professional. The provider shall 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.

(h) The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.

(i) A regional treatment team may serve multiple counties.