SF 5282

as introduced - 93rd Legislature (2023 - 2024) Posted on 04/03/2024 11:39am

A bill for an act
relating to direct care and treatment; modifying the eligible recipients and funding
for mental health innovation programs; removing county responsibility for the
cost of care for a client awaiting transfer to another state-operated facility or
program or facility operated by the Department of Corrections; appropriating
money for direct care and treatment capacity and utilization; amending Minnesota
Statutes 2022, sections 245.4662; 246.18, subdivision 4a; 246.54, subdivision 3;
Minnesota Statutes 2023 Supplement, section 246.54, subdivisions 1a, 1b.

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

Section 1.

Minnesota Statutes 2022, section 245.4662, is amended to read:

245.4662 MENTAL HEALTH INNOVATION GRANT PROGRAM.

Subdivision 1.

Definitions.

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

(b) "Community partnership" means a project involving the collaboration of two or more
deleted text begin eligible applicants deleted text end new text begin counties or a partnership between a county and a community mental
health provider or hospital new text end .

(c) "Eligible applicant" means an eligible county deleted text begin , Indian tribe, mental health service
provider, hospital, deleted text end or community partnership. Eligible applicant does not include a
state-operated direct care and treatment facility or program under chapter 246.

(d) "Intensive residential treatment services" has the meaning given in section 256B.0622.

(e) "Metropolitan area" means the seven-county metropolitan area, as defined in section
473.121, subdivision 2.

Subd. 2.

Grants authorized.

The commissioner of human services shall, in consultation
with stakeholders, award grants to eligible applicants to plan, establish, or operate programs
to improve accessibility and quality of community-based, outpatient mental health services
and reduce the number of clients admitted to deleted text begin regional treatment centers and community
behavioral health hospitals deleted text end new text begin and remaining in state-operated facilities or programs new text end . The
commissioner shall award half of all grant funds to eligible applicants in the metropolitan
area and half of all grant funds to eligible applicants outside the metropolitan area. An
applicant may apply for and the commissioner may award grants for two-year periods. The
commissioner may reallocate underspending among grantees within the same grant period.
The mental health innovation account is established under section 246.18 for ongoing
funding.

Subd. 3.

Allocation of grants.

(a) An application must be on a form and contain
information as specified by the commissioner but at a minimum must contain:

(1) a description of the purpose or project for which grant funds will be used;

(2) a description of the specific problem the grant funds will address;

deleted text begin (3) a letter of support from the local mental health authority;
deleted text end

deleted text begin (4) deleted text end new text begin (3) new text end a description of achievable objectives, a work plan, and a timeline for
implementation and completion of processes or projects enabled by the grant; and

deleted text begin (5) deleted text end new text begin (4) new text end a process for documenting and evaluating results of the grant.

(b) The commissioner shall review each application to determine whether the application
is complete and whether the applicant and the project are eligible for a grant. In evaluating
applications according to paragraph (c), the commissioner shall establish criteria including,
but not limited to: the eligibility of the project; the applicant's thoroughness and clarity in
describing the problem grant funds are intended to address; a description of the applicant's
proposed project; a description of the population demographics and service area of the
proposed project; the manner in which the applicant will demonstrate the effectiveness of
any projects undertaken; the proposed project's longevity and demonstrated financial
sustainability after the initial grant period; and evidence of efficiencies and effectiveness
gained through collaborative efforts. The commissioner may also consider other relevant
factors. In evaluating applications, the commissioner may request additional information
regarding a proposed project, including information on project cost. An applicant's failure
to provide the information requested disqualifies an applicant. The commissioner shall
determine the number of grants awarded.

(c) Eligible applicants may receive grants under this section for purposes including, but
not limited to, the following:

(1) intensive residential treatment services providing time-limited mental health services
in a residential setting;

(2) the creation of stand-alone urgent care centers for mental health and psychiatric
consultation services, crisis residential services, or collaboration between crisis teams and
critical access hospitals;

(3) establishing new community mental health services or expanding the capacity of
existing services, including supportive housing; and

(4) other innovative projects that improve options for mental health services in community
settings and reduce the number of clients who remain in deleted text begin regional treatment centers and
community behavioral health hospitals deleted text end new text begin state-operated facilities or programs new text end beyond when
discharge is determined to be clinically appropriate.

Sec. 2.

Minnesota Statutes 2022, section 246.18, subdivision 4a, is amended to read:

Subd. 4a.

Mental health innovation account.

The mental health innovation account is
established in the special revenue fund. deleted text begin Beginning in fiscal year 2018, $1,000,000 of deleted text end The
revenue generated by collection efforts from the Anoka-Metro Regional Treatment Center
and community behavioral health hospitals under section 246.54 must annually be deposited
into the mental health innovation account. Money deposited in the mental health innovation
account is appropriated to the commissioner of human services for the mental health
innovation grant program under section 245.4662.

Sec. 3.

Minnesota Statutes 2023 Supplement, section 246.54, subdivision 1a, is amended
to read:

Subd. 1a.

Anoka-Metro Regional Treatment Center.

(a) A county's payment of the
cost of care provided at Anoka-Metro Regional Treatment Center shall be according to the
following schedule:

(1) zero percent for the first 30 days;

(2) 20 percent for days 31 and over if the stay is determined to be clinically appropriate
for the client; and

(3) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged.

(b) If payments received by the state under sections 246.50 to 246.53 exceed 80 percent
of the cost of care for days over 31 for clients who meet the criteria in paragraph (a), clause
(2), the county shall be responsible for paying the state only the remaining amount. The
county shall not be entitled to reimbursement from the client, the client's estate, or from the
client's relatives, except as provided in section 246.53.

deleted text begin (c) Between July 1, 2023, and June 30, 2025, the county is not responsible for the cost
of care under paragraph (a), clause (3), for a person who is committed as a person who has
a mental illness and is dangerous to the public under section 253B.18 and who is awaiting
transfer to another state-operated facility or program. This paragraph expires June 30, 2025.
deleted text end

deleted text begin (d) deleted text end new text begin (c) new text end Notwithstanding any law to the contrary, the client is not responsible for payment
of the cost of care under this subdivision.

new text begin (d) The county is not responsible for the cost of care under paragraph (a), clause (3), if
the client is civilly committed and is awaiting transfer to another state-operated facility or
program or facility operated by the Department of Corrections.
new text end

Sec. 4.

Minnesota Statutes 2023 Supplement, section 246.54, subdivision 1b, is amended
to read:

Subd. 1b.

Community behavioral health hospitals.

(a) A county's payment of the cost
of care provided at state-operated community-based behavioral health hospitals for adults
and children shall be according to the following schedule:

(1) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged; and

(2) the county shall not be entitled to reimbursement from the client, the client's estate,
or from the client's relatives, except as provided in section 246.53.

deleted text begin (b) Between July 1, 2023, and June 30, 2025, the county is not responsible for the cost
of care under paragraph (a), clause (1), for a person committed as a person who has a mental
illness and is dangerous to the public under section 253B.18 and who is awaiting transfer
to another state-operated facility or program. This paragraph expires June 30, 2025.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Notwithstanding any law to the contrary, the client is not responsible for payment
of the cost of care under this subdivision.

new text begin (c) The county is not responsible for the cost of care under paragraph (a), clause (1), if
the client is civilly committed and is awaiting transfer to another state-operated facility or
program or facility operated by the Department of Corrections.
new text end

Sec. 5.

Minnesota Statutes 2022, section 246.54, subdivision 3, is amended to read:

Subd. 3.

Administrative review of county liability for cost of care.

(a) The county of
financial responsibility may submit a written request for administrative review by the
commissioner of the county's payment of the cost of care when a delay in discharge of a
client from a regional treatment center, state-operated community-based behavioral health
hospital, or other state-operated facility results from the following actions deleted text begin by the facility deleted text end new text begin or
circumstances new text end :

(1) the facility did not provide notice to the county that the facility has determined that
it is clinically appropriate for a client to be discharged;

(2) the new text begin facility's new text end notice to the county that the facility has determined that it is clinically
appropriate for a client to be discharged was communicated on a holiday or weekend;

(3) the new text begin facility did not complete the new text end required documentation or procedures for discharge
deleted text begin were not completed deleted text end in order for the discharge to occur in a timely manner; deleted text begin or
deleted text end

(4) the facility disagrees with the county's discharge plan deleted text begin . deleted text end new text begin ; or
new text end

new text begin (5) the county does not have the authority to approve a new placement for the client
upon the client's discharge from a state-operated facility.
new text end

(b) The county of financial responsibility may not appeal the determination that it is
clinically appropriate for a client to be discharged from a regional treatment center,
state-operated community-based behavioral health hospital, or other state-operated facility.

(c) The commissioner must evaluate the request for administrative review and determine
if the facility's actions listed in paragraph (a) caused undue delay in discharging the client.
If the commissioner determines that the deleted text begin facility's actions deleted text end new text begin circumstances new text end listed in paragraph
(a) caused undue delay in discharging the client, the county's liability must be reduced to
the level of the cost of care for a client whose stay in a facility is determined to be clinically
appropriate, effective on the date new text begin the circumstance arose or the date new text end of the facility's action
or failure to act that caused the delay. The commissioner's determination under this
subdivision is final and not subject to appeal.

(d) If a county's liability is reduced pursuant to paragraph (c), a county's liability must
return to the level of the cost of care for a client whose stay in a facility is determined to no
longer be appropriate effective on the date the facility rectifies the action or failure to act
that caused the delay under paragraph (a).

(e) Any difference in the county cost of care liability resulting from administrative review
under this subdivision must not be billed to the client or applied to future reimbursement
from the client's estate or relatives.

Sec. 6. new text begin DIRECT CARE AND TREATMENT CAPACITY AND UTILIZATION.
new text end

new text begin $....... in fiscal year 2025 is appropriated from the general fund to the commissioner of
human services to increase capacity and access to direct care and treatment services for all
levels of care. The commissioner must prioritize expanding capacity within the Forensic
Mental Health Program, Anoka Metro Regional Treatment Center, and community behavioral
health hospitals through reallocation of facility space and beds and maximization of staffing
levels. The commissioner must also use money appropriated under this section to examine
the utilization of beds at the Forensic Mental Health Program to identify opportunities for
most effective utilization of secured programming, and to develop and fund direct care and
treatment transitional support resources.
new text end