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Capital IconMinnesota Legislature
Office of the Revisor of Statutes

SF 982

as introduced - 92nd Legislature (2021 - 2022) Posted on 08/18/2021 02:57pm

KEY: stricken = removed, old language.
underscored = added, new language.
Version List Authors and Status
Pdf Rtf
Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28
2.29 2.30
2.31 2.32 2.33 2.34 2.35 2.36 2.37 2.38 2.39 2.40 2.41 2.42
2.43
3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23
3.24
3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 5.1 5.2 5.3 5.4 5.5
5.6
5.7 5.8 5.9 5.10 5.11
5.12
5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25
5.26
5.27 5.28 5.29 5.30 5.31 6.1 6.2
6.3
6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22
6.23
6.24 6.25 6.26 6.27 6.28
6.29
7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20
7.21
7.22 7.23 7.24 7.25 7.26 7.27 7.28
7.29
8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19
8.20
8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 9.1 9.2 9.3 9.4 9.5 9.6
9.7
9.8 9.9 9.10 9.11
9.12
9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23
9.24
9.25 9.26 9.27 9.28 9.29 9.30 9.31 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8
10.9
10.10 10.11 10.12 10.13
10.14
10.15 10.16 10.17 10.18 10.19 10.20
10.21
10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13
14.14
14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 15.1 15.2 15.3
15.4
15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31
15.32
16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17
16.18
16.19 16.20 16.21 16.22 16.23 16.24
16.25
16.26 16.27 16.28 16.29 16.30 16.31
16.32
17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21
17.22
17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31
17.32
18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13
20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 20.33 20.34 21.1 21.2 21.3 21.4 21.5
21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21
21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28
22.29 22.30 22.31 22.32
22.33
23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21
23.22
23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 24.1 24.2
24.3
24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9
25.10 25.11
25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19
29.20
29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 30.1 30.2
30.3
30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 31.1 31.2 31.3 31.4 31.5
31.6
31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21
31.22 31.23 31.24 31.25 31.26 31.27
31.28 31.29
32.1 32.2
32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 32.33 32.34 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 34.34 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31
35.32
36.1 36.2 36.3 36.4 36.5 36.6
36.7
36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15
36.16
36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28
39.29 39.30 39.31 39.32 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 40.33 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25
41.26 41.27 41.28 41.29 41.30 41.31 42.1 42.2 42.3 42.4 42.5
42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 42.33 43.1 43.2 43.3 43.4
43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 44.34 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27
45.28 45.29 45.30 45.31 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21
46.22
46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24
47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8
49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 50.1 50.2 50.3 50.4 50.5 50.6 50.7
50.8 50.9 50.10
50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 50.33 50.34 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17
51.18 51.19 51.20
51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14
52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9
54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28
55.29 55.30 55.31 55.32 55.33 55.34
56.1
56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8
57.9 57.10 57.11
57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 58.1 58.2 58.3 58.4 58.5 58.6 58.7
58.8 58.9 58.10
58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23
59.24 59.25 59.26
59.27 59.28 59.29 59.30 59.31 59.32 59.33 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17
60.18 60.19 60.20
60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 62.33 63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 67.33 68.1 68.2 68.3 68.4 68.5
68.6 68.7 68.8
68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 69.32 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 70.32 71.1 71.2 71.3 71.4
71.5
71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16
73.17 73.18 73.19
73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 75.1 75.2 75.3 75.4 75.5 75.6
75.7 75.8 75.9
75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13
77.14 77.15 77.16
77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32 77.33 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18
78.19
78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 78.34 79.1 79.2 79.3 79.4
79.5
79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18
79.19 79.20 79.21
79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17
80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20
81.21 81.22 81.23 81.24 81.25 81.26 81.27
81.28
81.29 81.30 81.31 81.32 82.1 82.2 82.3
82.4 82.5
82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13
82.14 82.15
82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 83.1 83.2 83.3
83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25
83.26
83.27 83.28 83.29 83.30 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30
88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 89.33 89.34 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8
90.9
90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 90.32 90.33 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 91.33 91.34 92.1 92.2 92.3
92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 92.32 92.33 92.34 92.35 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 93.33 93.34 93.35 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 94.33 94.34 94.35 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9
95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24
95.25
95.26 95.27 95.28 95.29 95.30 95.31 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9
96.10
96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 97.33 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14
98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25
100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 101.34 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13
102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28
102.29 102.30 102.31 102.32 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8
103.9 103.10 103.11 103.12 103.13
103.14
103.15 103.16 103.17 103.18
103.19
103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31
104.1
104.2 104.3
104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22
104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14
105.15 105.16 105.17 105.19 105.18 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 105.33 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 106.33 106.34 106.35 106.36 106.37 106.38 106.39 106.40 106.41 106.42 106.43 106.44 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 107.33 107.34 107.35 107.36 107.37 107.38 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30
110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8
110.9 110.10 110.11 110.12
110.13 110.14 110.15 110.16 110.17
110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 113.34 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 114.33 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 115.33 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23
118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 123.33 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22
124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15
125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26
125.27 125.28 125.29 125.30 125.31
126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10
126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 127.1 127.2
127.3 127.4 127.5 127.6
127.7 127.8 127.9 127.10 127.11
127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25
127.26 127.27 127.28 127.29 128.1 128.2
128.3 128.4 128.5 128.6
128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15
128.16 128.17 128.18 128.19 128.20 128.21 128.22
128.23 128.24 128.25 128.26 128.27 128.28
129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15
129.16 129.17 129.18
129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 131.1 131.2
131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18
131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33
133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19
133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10
134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21
134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26
135.27 135.28 135.29 135.30
136.1 136.2 136.3
136.4 136.5
136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24
136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 137.34 137.35 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30
138.31 138.32 138.33 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16
139.17
139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14
140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11
141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 143.1 143.2 143.3 143.4
143.5
143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20
147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24
148.25 148.26 148.27 148.28 148.29 148.30 149.1 149.2 149.3
149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32 149.33 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15
155.16 155.17
155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14
158.15 158.16
158.17 158.18 158.19 158.20 158.21
158.22 158.23
158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 159.1 159.2 159.3 159.4 159.5 159.6 159.7
159.8
159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 159.32 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 160.34 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12
161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 161.33 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31
163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 163.33 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 164.33 164.34 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 165.33 165.34 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32
167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22
167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32
168.1 168.2 168.3
168.4
168.5 168.6
168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15
168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9
170.10 170.11
170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 171.34 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23
174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21
177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13
183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23
186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 189.1 189.2 189.3 189.4 189.5
189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27
189.28 189.29 189.30 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15
191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23
192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 197.33 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11
200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23
202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 203.33 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23
204.24 204.25 204.26 204.27 204.28 204.29
205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 205.33 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 208.32 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 209.33 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 210.32 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29
211.30 211.31 211.32 211.33 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 215.33 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 222.33 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12
224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 228.32 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32 234.33 234.34 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 235.33 235.34 236.1 236.2 236.3
236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13
236.14 236.15
236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 237.1 237.2 237.3
237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9
238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29
239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 239.33 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 240.33 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 245.33 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 247.34 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 248.32 248.33 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 249.32 249.33 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16
253.17 253.18 253.19
253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30
254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15
254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29
255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19
255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19
256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29
257.30 257.31 257.32 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22
258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 258.33 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24
259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 259.33 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19
260.20 260.21 260.22
260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 261.1 261.2 261.3 261.4 261.5 261.6
261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26
261.27 261.28 261.29 261.30 261.31 261.32 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27
262.28 262.29 262.30 262.31 262.32 263.1 263.2 263.3 263.4
263.5 263.6 263.7 263.8 263.9
263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22
265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24
266.25 266.26 266.27 266.28 266.29 266.30 266.31
267.1 267.2 267.3 267.4 267.5 267.6 267.7
267.8 267.9 267.10 267.11
267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26
267.27 267.28 267.29 267.30 267.31 268.1 268.2 268.3 268.4 268.5 268.6 268.7
268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22
268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 268.32 268.33 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8
269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32
270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29
271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9
271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 272.1 272.2 272.3 272.4 272.5 272.6
272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23
272.24 272.25 272.26 272.27 272.28 272.29 272.30 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19
273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 273.32 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17
274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 275.1 275.2 275.3 275.4 275.5 275.6
275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17
275.18 275.19 275.20 275.21
275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29
276.30 276.31 276.32 276.33 277.1 277.2 277.3
277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19
277.20 277.21 277.22 277.23 277.24 277.25 277.26
277.27 277.28 277.29 277.30 277.31 277.32 277.33
278.1 278.2 278.3 278.4
278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19
278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31 278.32 278.33 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9
279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 280.1 280.2
280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17
280.18 280.19 280.20 280.21
280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 281.32 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 282.32 282.33 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23
283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16
284.17 284.18 284.19 284.21 284.20 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33 284.34 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 285.32 285.33 285.34 285.35 285.36 285.37 285.38 285.39 285.40 285.41 285.42 285.43 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 286.32 286.33 286.34 286.35 286.36 286.37 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 287.33 287.34 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28
288.29 288.30 288.31 288.32 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 289.33 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20
290.21 290.22 290.23 290.24 290.25
290.26 290.27 290.28 290.29 290.30 290.31
291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10
291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18
291.19 291.20 291.21 291.22
291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 292.1 292.2
292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13
292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 293.33 293.34 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 294.32 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 295.32 295.33 296.1 296.2 296.3 296.4 296.5 296.6
296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12
297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 297.32 298.1 298.2
298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 298.33 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8
300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 300.32 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 303.33 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8
304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 304.32 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 306.32
307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 307.32 308.1 308.2 308.3 308.4 308.5
308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 309.33 309.34 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11
310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22
310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 310.33 311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20
311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 311.32
312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 312.32 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23
313.24 313.25 313.26 313.27 313.28 313.29 313.30 313.31 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 315.32
316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 316.32 316.33 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 318.1 318.2 318.3 318.4 318.5 318.6 318.7
318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21
318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22
319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 319.33 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18
321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28
322.29 322.30 322.31 322.32 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8
323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22
323.23 323.24 323.25 323.26 323.27 323.28
323.29 323.30 323.31 323.32 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9
324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30
325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20
326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18
327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18
328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 329.33 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 330.33 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17
332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 333.1 333.2 333.3
333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31
334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18
334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 334.33 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27
335.28 335.29 335.30 336.1 336.2
336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 337.33 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 340.1 340.2 340.3 340.4
340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 341.1 341.2 341.3
341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 341.34 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 342.33 342.34 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 343.32 343.33 343.34 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9
345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31
346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23
346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32
349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32
350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16
350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 352.1 352.2 352.3
352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25
352.26 352.27 352.28 352.29 353.1 353.2 353.3
353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28
355.29 355.30 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17
356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 358.1 358.2 358.3 358.4
358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17
360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27
362.28 362.29 362.30 362.31 362.32 362.33 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15
363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23
365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 366.1 366.2 366.3 366.4 366.5
366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19
366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31
367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30
368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14
369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30
370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18
371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30 372.31 372.32 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8
373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20
373.21 373.22
373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 374.1 374.2
374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 375.1 375.2 375.3 375.4 375.5
375.6 375.7
375.8 375.9
375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21
375.22 375.23 375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32 376.33 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 377.31 377.32 377.33 377.34 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 378.32 378.33 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 379.31 379.32 379.33 379.34 379.35 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30 380.31 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 381.33 381.34 381.35 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 382.33 382.34 382.35 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 383.32 383.33 383.34 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 384.33 384.34 384.35 385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 385.32 385.33 385.34 385.35 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 386.31 386.32 386.33 386.34 386.35 387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 387.32 387.33 387.34 387.35 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 388.31 388.32 388.33 388.34 388.35 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 389.33 389.34 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 390.32 390.33 390.34
391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21
391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29
391.30
392.1 392.2 392.3 392.4
392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22
392.23 392.24 392.25
392.26 392.27 392.28
392.29 392.30

A bill for an act
 relating to state government; modifying provisions governing children and family
services, community supports, direct care and treatment, health care, human services
licensing and background studies, and chemical and mental health services; making
forecast adjustments; requiring reports; transferring money; making technical and
conforming changes; appropriating money; amending Minnesota Statutes 2020,
sections 62A.152, subdivision 3; 62A.3094, subdivision 1; 62Q.096; 62V.05, by
adding a subdivision; 119B.011, subdivision 15; 119B.025, subdivision 4; 119B.13,
subdivision 1; 122A.18, subdivision 8; 144.651, subdivision 2; 144D.01,
subdivision 4; 144G.08, subdivision 7, as amended; 148B.5301, subdivision 2;
148E.120, subdivision 2; 148F.11, subdivision 1; 174.30, subdivision 3; 245.462,
subdivisions 1, 6, 8, 9, 14, 16, 17, 18, 21, 23, by adding a subdivision; 245.4661,
subdivision 5; 245.4662, subdivision 1; 245.467, subdivisions 2, 3; 245.469,
subdivisions 1, 2; 245.470, subdivision 1; 245.4712, subdivision 2; 245.472,
subdivision 2; 245.4863; 245.4871, subdivisions 9a, 10, 11a, 17, 21, 26, 27, 29,
31, 32, 34, by adding a subdivision; 245.4876, subdivisions 2, 3; 245.4879,
subdivision 1; 245.488, subdivision 1; 245.4901, subdivision 2; 245.62, subdivision
2; 245.735, subdivision 3; 245A.03, subdivision 7; 245A.04, subdivision 5;
245A.10, subdivision 4; 245A.65, subdivision 2; 245C.02, by adding subdivisions;
245C.03; 245C.05, subdivisions 1, 2, 2a, 2b, 4; 245C.08, by adding subdivisions;
245C.10, subdivision 15, by adding subdivisions; 245C.13, subdivision 2; 245C.14,
by adding a subdivision; 245C.16, subdivisions 1, 2; 245C.17, subdivision 1, by
adding a subdivision; 245C.18; 245D.02, subdivision 20; 246.54, subdivision 1b;
254B.05, subdivision 5; 256.042, subdivisions 2, 4; 256.043, subdivision 3;
256.9695, subdivision 1; 256.983; 256B.04, subdivisions 12, 14; 256B.057,
subdivision 3; 256B.0615, subdivisions 1, 5; 256B.0616, subdivisions 1, 3, 5;
256B.0622, subdivisions 1, 2, 3a, 4, 7, 7a, 7b, 7c, 7d; 256B.0623, subdivisions 1,
2, 3, 4, 5, 6, 9, 12; 256B.0624; 256B.0625, subdivisions 3b, 5, 9, 13, 13e, 17, 17b,
18, 18b, 19c, 20, 28a, 42, 48, 49, 56a, 58; 256B.0757, subdivision 4c; 256B.0759,
subdivisions 2, 4; 256B.092, subdivisions 4, 5, 12; 256B.0924, subdivision 6;
256B.094, subdivision 6; 256B.0941, subdivision 1; 256B.0943, subdivisions 1,
2, 3, 4, 5, 5a, 6, 7, 9, 11; 256B.0946, subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947,
subdivisions 1, 2, 3, 3a, 5, 6, 7; 256B.0949, subdivisions 2, 4, 5a, 13, by adding a
subdivision; 256B.25, subdivision 3; 256B.49, subdivisions 11, 11a, 17, by adding
a subdivision; 256B.4914, subdivisions 5, 6, 7, 8, 9, by adding a subdivision;
256B.69, subdivision 6d; 256B.75; 256B.76, subdivisions 2, 4; 256B.761;
256B.763; 256B.766; 256B.767; 256B.79, subdivisions 1, 3; 256D.03, by adding
a subdivision; 256D.051, by adding subdivisions; 256D.0516, subdivision 2;
256E.30, subdivision 2; 256E.34, subdivision 1; 256I.03, subdivision 13; 256I.05,
subdivisions 1a, 11; 256I.06, subdivisions 6, 8; 256J.08, subdivisions 71, 79;
256J.21, subdivisions 2, 3, 4; 256J.33, subdivisions 1, 2; 256J.37, subdivisions 3,
3a; 256J.626, subdivision 1; 256L.01, subdivision 5; 256L.04, subdivision 7b;
256L.05, subdivision 3a; 256L.11, subdivision 7; 256N.25, subdivisions 2, 3;
256N.26, subdivisions 11, 13; 256P.01, subdivision 6a, by adding a subdivision;
256P.04, subdivisions 4, 8; 256P.06, subdivision 3; 256P.07; 295.50, subdivision
9b; 325F.721, subdivision 1; Laws 2017, chapter 13, article 1, section 15, as
amended; proposing coding for new law in Minnesota Statutes, chapters 245C;
256B; 256P; proposing coding for new law as Minnesota Statutes, chapter 245I;
repealing Minnesota Statutes 2020, sections 245.462, subdivision 4a; 245.4879,
subdivision 2; 245.62, subdivisions 3, 4; 245.69, subdivision 2; 245A.191; 245C.10,
subdivisions 2, 2a, 3, 4, 5, 6, 7, 8, 9, 9a, 10, 11, 12, 13, 14, 16; 256B.0596;
256B.0615, subdivision 2; 256B.0616, subdivision 2; 256B.0622, subdivisions 3,
5a; 256B.0623, subdivisions 7, 8, 10, 11; 256B.0625, subdivisions 5l, 18c, 18d,
18e, 18h, 35a, 35b, 61, 62, 65; 256B.0916, subdivisions 2, 3, 4, 5, 8, 11, 12;
256B.0943, subdivisions 8, 10; 256B.0944; 256B.0946, subdivision 5; 256B.097;
256B.49, subdivisions 26, 27; 256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b,
6c, 7, 8, 9, 18; 256D.052, subdivision 3; 256J.08, subdivisions 10, 53, 61, 62, 81,
83; 256J.30, subdivisions 5, 7, 8; 256J.33, subdivisions 3, 4, 5; 256J.34,
subdivisions 1, 2, 3, 4; 256J.37, subdivision 10; 256L.11, subdivision 6a; Minnesota
Rules, parts 9505.0370; 9505.0371; 9505.0372; 9520.0010; 9520.0020; 9520.0030;
9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090; 9520.0100;
9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160; 9520.0170;
9520.0180; 9520.0190; 9520.0200; 9520.0210; 9520.0230; 9520.0750; 9520.0760;
9520.0770; 9520.0780; 9520.0790; 9520.0800; 9520.0810; 9520.0820; 9520.0830;
9520.0840; 9520.0850; 9520.0860; 9520.0870.

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

ARTICLE 1

CHILDREN AND FAMILY SERVICES

Section 1.

Minnesota Statutes 2020, section 119B.011, subdivision 15, is amended to read:


Subd. 15.

Income.

"Income" means earned income as defined under section 256P.01,
subdivision 3, unearned income as defined under section 256P.01, subdivision 8, and public
assistance cash benefits, including the Minnesota family investment program, diversionary
work program, work benefit, Minnesota supplemental aid, general assistance, refugee cash
assistance, at-home infant child care subsidy payments, and child support and maintenance
distributed to deleted text begin thedeleted text end new text begin anew text end family under section 256.741, subdivision 2anew text begin , and nonrecurring income
over $60 per quarter unless earmarked and used for the purpose for which it was intendednew text end .
The following are deducted from income: funds used to pay for health insurance premiums
for family members, and child or spousal support paid to or on behalf of a person or persons
who live outside of the household. Income sources new text begin that are new text end not included in this subdivision
and section 256P.06, subdivision 3, are not countednew text begin as incomenew text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

Minnesota Statutes 2020, section 119B.025, subdivision 4, is amended to read:


Subd. 4.

Changes in eligibility.

(a) The county shall process a change in eligibility
factors according to paragraphs (b) to (g).

(b) A family is subject to the reporting requirements in section 256P.07new text begin , subdivision 6new text end .

(c) If a family reports a change or a change is known to the agency before the family's
regularly scheduled redetermination, the county must act on the change. The commissioner
shall establish standards for verifying a change.

(d) A change in income occurs on the day the participant received the first payment
reflecting the change in income.

(e) During a family's 12-month eligibility period, if the family's income increases and
remains at or below 85 percent of the state median income, adjusted for family size, there
is no change to the family's eligibility. The county shall not request verification of the
change. The co-payment fee shall not increase during the remaining portion of the family's
12-month eligibility period.

(f) During a family's 12-month eligibility period, if the family's income increases and
exceeds 85 percent of the state median income, adjusted for family size, the family is not
eligible for child care assistance. The family must be given 15 calendar days to provide
verification of the change. If the required verification is not returned or confirms ineligibility,
the family's eligibility ends following a subsequent 15-day adverse action notice.

(g) Notwithstanding Minnesota Rules, parts 3400.0040, subpart 3, and 3400.0170,
subpart 1, if an applicant or participant reports that employment ended, the agency may
accept a signed statement from the applicant or participant as verification that employment
ended.

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2020, section 119B.13, subdivision 1, is amended to read:


Subdivision 1.

Subsidy restrictions.

(a) The maximum rate paid for child care assistance
in any county or county price cluster under the child care fund shall be the greater of the
deleted text begin 25thdeleted text end new text begin 30thnew text end percentile of the deleted text begin 2018deleted text end new text begin most recentnew text end child care provider rate survey or the rates in
effect at the time of the update. new text begin The rate increase shall be effective the first full service
period on or after January 1 of the year following the provider rate survey. new text end For a child care
provider located within the boundaries of a city located in two or more of the counties of
Benton, Sherburne, and Stearns, the maximum rate paid for child care assistance shall be
equal to the maximum rate paid in the county with the highest maximum reimbursement
rates or the provider's charge, whichever is less. The commissioner may: (1) assign a county
with no reported provider prices to a similar price cluster; and (2) consider county level
access when determining final price clusters.

(b) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.

(c) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.

(d) If a child uses one provider, the maximum payment for one day of care must not
exceed the daily rate. The maximum payment for one week of care must not exceed the
weekly rate.

(e) If a child uses two providers under section 119B.097, the maximum payment must
not exceed:

(1) the daily rate for one day of care;

(2) the weekly rate for one week of care by the child's primary provider; and

(3) two daily rates during two weeks of care by a child's secondary provider.

(f) Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.

(g) If the provider charge is greater than the maximum provider rate allowed, the parent
is responsible for payment of the difference in the rates in addition to any family co-payment
fee.

deleted text begin (h) All maximum provider rates changes shall be implemented on the Monday following
the effective date of the maximum provider rate.
 deleted text end

deleted text begin (i) Beginning September 21, 2020,deleted text end new text begin (h)new text end The maximum registration fee paid for child care
assistance in any county or county price cluster under the child care fund shall be the greater
of the deleted text begin 25thdeleted text end new text begin 30thnew text end percentile of the deleted text begin 2018deleted text end new text begin most recentnew text end child care provider rate survey or the
registration fee in effect at the time of the update. new text begin Each maximum registration fee update
must be implemented on the same schedule as maximum child care assistance rate increases
under paragraph (a). new text end Maximum registration fees must be set for licensed family child care
and for child care centers. For a child care provider located in the boundaries of a city located
in two or more of the counties of Benton, Sherburne, and Stearns, the maximum registration
fee paid for child care assistance shall be equal to the maximum registration fee paid in the
county with the highest maximum registration fee or the provider's charge, whichever is
less.

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2020, section 256D.03, is amended by adding a subdivision to
read:


new text begin Subd. 2b. new text end

new text begin Budgeting and reporting. new text end

new text begin County agencies shall determine eligibility and
calculate benefit amounts for general assistance according to the provisions in sections
256P.06, 256P.07, 256P.09, and 256P.10.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:


new text begin Subd. 20. new text end

new text begin SNAP employment and training. new text end

new text begin The commissioner shall implement a
Supplemental Nutrition Assistance Program (SNAP) employment and training program
that meets the SNAP employment and training participation requirements of the United
States Department of Agriculture governed by Code of Federal Regulations, title 7, section
273.7. The commissioner shall operate a SNAP employment and training program in which
SNAP recipients elect to participate. In order to receive SNAP assistance beyond the time
limit, unless residing in an area covered by a time-limit waiver governed by Code of Federal
Regulations, title 7, section 273.24, nonexempt SNAP recipients who do not meet federal
SNAP work requirements must participate in an employment and training program. In
addition to county and tribal agencies that administer SNAP, the commissioner may contract
with third-party providers for SNAP employment and training services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2021.
 new text end

Sec. 6.

Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:


new text begin Subd. 21. new text end

new text begin County and tribal agency duties. new text end

new text begin County or tribal agencies that administer
SNAP shall inform adult SNAP recipients about employment and training services and
providers in the recipient's area. County or tribal agencies that administer SNAP may elect
to subcontract with a public or private entity approved by the commissioner to provide
SNAP employment and training services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2021.
 new text end

Sec. 7.

Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:


new text begin Subd. 22. new text end

new text begin Duties of commissioner. new text end

new text begin In addition to any other duties imposed by law, the
commissioner shall:
 new text end

new text begin (1) supervise the administration of SNAP employment and training services to county,
tribal, and contracted agencies under this section and Code of Federal Regulations, title 7,
section 273.7;
 new text end

new text begin (2) disburse money allocated and reimbursed for SNAP employment and training services
to county, tribal, and contracted agencies;
 new text end

new text begin (3) accept and supervise the disbursement of any funds that may be provided by the
federal government or other sources for SNAP employment and training services;
 new text end

new text begin (4) cooperate with other agencies, including any federal agency or agency of another
state, in all matters concerning the powers and duties of the commissioner under this section;
 new text end

new text begin (5) coordinate with the commissioner of employment and economic development to
deliver employment and training services statewide;
 new text end

new text begin (6) work in partnership with counties, tribes, and other agencies to enhance the reach
and services of a statewide SNAP employment and training program; and
 new text end

new text begin (7) identify eligible nonfederal funds to earn federal reimbursement for SNAP
employment and training services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2021.
 new text end

Sec. 8.

Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:


new text begin Subd. 23. new text end

new text begin Participant duties. new text end

new text begin Unless residing in an area covered by a time-limit waiver,
nonexempt SNAP recipients must meet federal SNAP work requirements to receive SNAP
assistance beyond the time limit.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2021.
 new text end

Sec. 9.

Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:


new text begin Subd. 24. new text end

new text begin Program funding. new text end

new text begin (a) The United States Department of Agriculture annually
allocates SNAP employment and training funds to the commissioner of human services for
the operation of the SNAP employment and training program.
 new text end

new text begin (b) The United States Department of Agriculture authorizes the disbursement of SNAP
employment and training reimbursement funds to the commissioner of human services for
the operation of the SNAP employment and training program.
 new text end

new text begin (c) Except for funds allocated for state program development and administrative purposes
or designated by the United States Department of Agriculture for a specific project, the
commissioner of human services shall disburse money allocated for federal SNAP
employment and training to counties and tribes that administer SNAP based on a formula
determined by the commissioner that includes but is not limited to the county's or tribe's
proportion of adult SNAP recipients as compared to the statewide total.
 new text end

new text begin (d) The commissioner of human services shall disburse federal funds that the
commissioner receives as reimbursement for SNAP employment and training costs to the
state agency, county, tribe, or contracted agency that incurred the costs being reimbursed.
 new text end

new text begin (e) The commissioner of human services may reallocate unexpended money disbursed
under this section to county, tribal, or contracted agencies that demonstrate a need for
additional funds.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2021.
 new text end

Sec. 10.

Minnesota Statutes 2020, section 256D.0516, subdivision 2, is amended to read:


Subd. 2.

SNAP reporting requirements.

The commissioner of human services shall
implement simplified reporting as permitted under the Food and Nutrition Act of 2008, as
amended, and the SNAP regulations in Code of Federal Regulations, title 7, part 273. SNAP
benefit recipient households required to report periodically shall not be required to report
more often than one time every six months. deleted text begin This provision shall not apply to households
receiving food benefits under the Minnesota family investment program waiver.
deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 11.

Minnesota Statutes 2020, section 256E.30, subdivision 2, is amended to read:


Subd. 2.

Allocation of money.

(a) State money appropriated and community service
block grant money allotted to the state and all money transferred to the community service
block grant from other block grants shall be allocated annually to community action agencies
and Indian reservation governments under paragraphs (b) and (c), and to migrant and seasonal
farmworker organizations under paragraph (d).

(b) The available annual money will provide base funding to all community action
agencies and the Indian reservations. Base funding amounts per agency are as follows: for
agencies with low income populations up to deleted text begin 1,999, $25,000; 2,000 todeleted text end 23,999, $50,000; and
24,000 or more, $100,000.

(c) All remaining money of the annual money available after the base funding has been
determined must be allocated to each agency and reservation in proportion to the size of
the poverty level population in the agency's service area compared to the size of the poverty
level population in the state.

(d) Allocation of money to migrant and seasonal farmworker organizations must not
exceed three percent of the total annual money available. Base funding allocations must be
made for all community action agencies and Indian reservations that received money under
this subdivision, in fiscal year 1984, and for community action agencies designated under
this section with a service area population of 35,000 or greater.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021.
 new text end

Sec. 12.

Minnesota Statutes 2020, section 256E.34, subdivision 1, is amended to read:


Subdivision 1.

Distribution of appropriation.

The commissioner must distribute funds
appropriated to the commissioner by law for that purpose to Hunger Solutions, a statewide
association of food shelves organized as a nonprofit corporation as defined under section
501(c)(3) of the Internal Revenue Code of 1986, to distribute to qualifying food shelves. A
food shelf qualifies under this section if:

(1) it is a nonprofit corporation, or is affiliated with a nonprofit corporation, as defined
in section 501(c)(3) of the Internal Revenue Code of 1986new text begin or a federally recognized tribal
nationnew text end ;

(2) it distributes standard food orders without charge to needy individuals. The standard
food order must consist of at least a two-day supply or six pounds per person of nutritionally
balanced food items;

(3) it does not limit food distributions to individuals of a particular religious affiliation,
race, or other criteria unrelated to need or to requirements necessary to administration of a
fair and orderly distribution system;

(4) it does not use the money received or the food distribution program to foster or
advance religious or political views; and

(5) it has a stable address and directly serves individuals.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021.
 new text end

Sec. 13.

Minnesota Statutes 2020, section 256I.03, subdivision 13, is amended to read:


Subd. 13.

Prospective budgeting.

"Prospective budgeting" deleted text begin means estimating the amount
of monthly income a person will have in the payment monthdeleted text end new text begin has the meaning given in
section 256P.01, subdivision 9new text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 14.

Minnesota Statutes 2020, section 256I.06, subdivision 6, is amended to read:


Subd. 6.

Reports.

Recipients must report changes in circumstances according to section
256P.07 deleted text begin that affect eligibility or housing support payment amounts, other than changes in
earned income, within ten days of the changedeleted text end . Recipients with countable earned income
must complete a household report form at least once every six monthsnew text begin according to section
256P.10new text end . deleted text begin If the report form is not received before the end of the month in which it is due,
the county agency must terminate eligibility for housing support payments. The termination
shall be effective on the first day of the month following the month in which the report was
due. If a complete report is received within the month eligibility was terminated, the
individual is considered to have continued an application for housing support payment
effective the first day of the month the eligibility was terminated.
deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 15.

Minnesota Statutes 2020, section 256I.06, subdivision 8, is amended to read:


Subd. 8.

Amount of housing support payment.

(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision 1c, paragraph (d).

deleted text begin (b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end For an individual who receives housing support payments under section 256I.04,
subdivision 1, paragraph (c), the amount of the housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.

new text begin EFFECTIVE DATE. new text end

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

Sec. 16.

Minnesota Statutes 2020, section 256J.08, subdivision 71, is amended to read:


Subd. 71.

Prospective budgeting.

"Prospective budgeting" deleted text begin means a method of
determining the amount of the assistance payment in which the budget month and payment
month are the samedeleted text end new text begin has the meaning given in section 256P.01, subdivision 9new text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 17.

Minnesota Statutes 2020, section 256J.08, subdivision 79, is amended to read:


Subd. 79.

Recurring income.

"Recurring income" means a form of income which is:

(1) received periodically, and may be received irregularly when receipt can be anticipated
even though the date of receipt cannot be predicted; and

(2) from the same source or of the same type that is received and budgeted in a
prospective month deleted text begin and is received in one or both of the first two retrospective monthsdeleted text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 18.

Minnesota Statutes 2020, section 256J.21, subdivision 2, is amended to read:


Subd. 2.

Income exclusions.

The following must be excluded in determining a family's
available income:

(1) payments for basic care, difficulty of care, and clothing allowances received for
providing family foster care to children or adults under Minnesota Rules, parts 9555.5050
to 9555.6265, 9560.0521, and 9560.0650 to 9560.0654, payments for family foster care for
children under section 260C.4411 or chapter 256N, and payments received and used for
care and maintenance of a third-party beneficiary who is not a household member;

(2) reimbursements for employment training received through the Workforce Investment
Act of 1998, United States Code, title 20, chapter 73, section 9201;

(3) reimbursement for out-of-pocket expenses incurred while performing volunteer
services, jury duty, employment, or informal carpooling arrangements directly related to
employment;

(4) all educational assistance, except the county agency must count graduate student
teaching assistantships, fellowships, and other similar paid work as earned income and,
after allowing deductions for any unmet and necessary educational expenses, shall count
scholarships or grants awarded to graduate students that do not require teaching or research
as unearned income;

(5) loans, regardless of purpose, from public or private lending institutions, governmental
lending institutions, or governmental agencies;

(6) loans from private individuals, regardless of purpose, provided an applicant or
participant documents that the lender expects repayment;

(7)(i) state income tax refunds; and

(ii) federal income tax refunds;

(8)(i) federal earned income credits;

(ii) Minnesota working family credits;

(iii) state homeowners and renters credits under chapter 290A; and

(iv) federal or state tax rebates;

(9) funds received for reimbursement, replacement, or rebate of personal or real property
when these payments are made by public agencies, awarded by a court, solicited through
public appeal, or made as a grant by a federal agency, state or local government, or disaster
assistance organizations, subsequent to a presidential declaration of disaster;

(10) the portion of an insurance settlement that is used to pay medical, funeral, and burial
expenses, or to repair or replace insured property;

(11) reimbursements for medical expenses that cannot be paid by medical assistance;

(12) payments by a vocational rehabilitation program administered by the state under
chapter 268A, except those payments that are for current living expenses;

(13) in-kind income, including any payments directly made by a third party to a provider
of goods and services;

(14) assistance payments to correct underpayments, but only for the month in which the
payment is received;

(15) payments for short-term emergency needs under section 256J.626, subdivision 2;

(16) funeral and cemetery payments as provided by section 256.935;

(17) nonrecurring cash gifts deleted text begin of $30 or less, not exceeding $30 per participant in a calendar
monthdeleted text end ;

(18) any form of energy assistance payment made through Public Law 97-35,
Low-Income Home Energy Assistance Act of 1981, payments made directly to energy
providers by other public and private agencies, and any form of credit or rebate payment
issued by energy providers;

(19) Supplemental Security Income (SSI), including retroactive SSI payments and other
income of an SSI recipient;

(20) Minnesota supplemental aid, including retroactive payments;

(21) proceeds from the sale of real or personal property;

(22) adoption or kinship assistance payments under chapter 256N or 259A and Minnesota
permanency demonstration title IV-E waiver payments;

(23) state-funded family subsidy program payments made under section 252.32 to help
families care for children with developmental disabilities, consumer support grant funds
under section 256.476, and resources and services for a disabled household member under
one of the home and community-based waiver services programs under chapter 256B;

(24) interest payments and dividends from property that is not excluded from and that
does not exceed the asset limit;

(25) rent rebates;

(26) income earned by a minor caregiver, minor child through age 6, or a minor child
who is at least a half-time student in an approved elementary or secondary education program;

(27) income earned by a caregiver under age 20 who is at least a half-time student in an
approved elementary or secondary education program;

(28) MFIP child care payments under section 119B.05;

(29) all other payments made through MFIP to support a caregiver's pursuit of greater
economic stability;

(30) income a participant receives related to shared living expenses;

(31) reverse mortgages;

(32) benefits provided by the Child Nutrition Act of 1966, United States Code, title 42,
chapter 13A, sections 1771 to 1790;

(33) benefits provided by the women, infants, and children (WIC) nutrition program,
United States Code, title 42, chapter 13A, section 1786;

(34) benefits from the National School Lunch Act, United States Code, title 42, chapter
13, sections 1751 to 1769e;

(35) relocation assistance for displaced persons under the Uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970, United States Code, title 42, chapter
61, subchapter II, section 4636, or the National Housing Act, United States Code, title 12,
chapter 13, sections 1701 to 1750jj;

(36) benefits from the Trade Act of 1974, United States Code, title 19, chapter 12, part
2, sections 2271 to 2322;

(37) war reparations payments to Japanese Americans and Aleuts under United States
Code, title 50, sections 1989 to 1989d;

(38) payments to veterans or their dependents as a result of legal settlements regarding
Agent Orange or other chemical exposure under Public Law 101-239, section 10405,
paragraph (a)(2)(E);

(39) income that is otherwise specifically excluded from MFIP consideration in federal
law, state law, or federal regulation;

(40) security and utility deposit refunds;

(41) American Indian tribal land settlements excluded under Public Laws 98-123, 98-124,
and 99-377 to the Mississippi Band Chippewa Indians of White Earth, Leech Lake, and
Mille Lacs reservations and payments to members of the White Earth Band, under United
States Code, title 25, chapter 9, section 331, and chapter 16, section 1407;

(42) all income of the minor parent's parents and stepparents when determining the grant
for the minor parent in households that include a minor parent living with parents or
stepparents on MFIP with other children;

(43) income of the minor parent's parents and stepparents equal to 200 percent of the
federal poverty guideline for a family size not including the minor parent and the minor
parent's child in households that include a minor parent living with parents or stepparents
not on MFIP when determining the grant for the minor parent. The remainder of income is
deemed as specified in section 256J.37, subdivision 1b;

(44) payments made to children eligible for relative custody assistance under section
257.85;

(45) vendor payments for goods and services made on behalf of a client unless the client
has the option of receiving the payment in cash;

(46) the principal portion of a contract for deed payment;

(47) cash payments to individuals enrolled for full-time service as a volunteer under
AmeriCorps programs including AmeriCorps VISTA, AmeriCorps State, AmeriCorps
National, and AmeriCorps NCCC;

(48) housing assistance grants under section 256J.35, paragraph (a); and

(49) child support payments of up to $100 for an assistance unit with one child and up
to $200 for an assistance unit with two or more children.

new text begin EFFECTIVE DATE. new text end

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

Sec. 19.

Minnesota Statutes 2020, section 256J.21, subdivision 3, is amended to read:


Subd. 3.

Initial income test.

The agency shall determine initial eligibility by considering
all earned and unearned income that is not excluded under subdivision 2. To be eligible for
MFIP, the assistance unit's countable income minus the earned income disregards in
paragraph (a) and section 256P.03 must be below the family wage level according to section
256J.24new text begin , subdivision 7,new text end for that size assistance unit.

(a) The initial eligibility determination must disregard the following items:

(1) the earned income disregard as determined in section 256P.03;

(2) dependent care costs must be deducted from gross earned income for the actual
amount paid for dependent care up to a maximum of $200 per month for each child less
than two years of age, and $175 per month for each child two years of age and older;

(3) all payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household shall be disregarded from the income
of the person with the legal obligation to pay support; and

(4) an allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver according to section 256J.36.

(b) deleted text begin After initial eligibility is established,deleted text end new text begin The income test is for a six-month period.new text end The
assistance payment calculation is based on deleted text begin the monthly income testdeleted text end new text begin prospective budgeting
according to section 256P.09new text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 20.

Minnesota Statutes 2020, section 256J.21, subdivision 4, is amended to read:


Subd. 4.

deleted text begin Monthlydeleted text end Income test and determination of assistance payment.

deleted text begin The county
agency shall determine ongoing eligibility and the assistance payment amount according
to the monthly income test.deleted text end To be eligible for MFIP, the result of the computations in
paragraphs (a) to (e) new text begin applied to prospective budgeting new text end must be at least $1.

(a) Apply an income disregard as defined in section 256P.03, to gross earnings and
subtract this amount from the family wage level. If the difference is equal to or greater than
the MFIP transitional standard, the assistance payment is equal to the MFIP transitional
standard. If the difference is less than the MFIP transitional standard, the assistance payment
is equal to the difference. The earned income disregard in this paragraph must be deducted
every month there is earned income.

(b) All payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household must be disregarded from the income
of the person with the legal obligation to pay support.

(c) An allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver must be made according to section 256J.36.

(d) Subtract unearned income dollar for dollar from the MFIP transitional standard to
determine the assistance payment amount.

(e) When income is both earned and unearned, the amount of the assistance payment
must be determined by first treating gross earned income as specified in paragraph (a). After
determining the amount of the assistance payment under paragraph (a), unearned income
must be subtracted from that amount dollar for dollar to determine the assistance payment
amount.

deleted text begin (f) When the monthly income is greater than the MFIP transitional standard after
deductions and the income will only exceed the standard for one month, the county agency
must suspend the assistance payment for the payment month.
 deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 21.

Minnesota Statutes 2020, section 256J.33, subdivision 1, is amended to read:


Subdivision 1.

Determination of eligibility.

A county agency must determine MFIP
eligibility prospectively deleted text begin for a payment monthdeleted text end based on deleted text begin retrospectivelydeleted text end assessing income
and the county agency's best estimate of the circumstances that will exist in the payment
month.

deleted text begin Except as described in section 256J.34, subdivision 1, when prospective eligibility exists,deleted text end
A county agency must calculate the amount of the assistance payment using deleted text begin retrospectivedeleted text end new text begin
prospectivenew text end budgeting. To determine MFIP eligibility and the assistance payment amount,
a county agency must apply countable income, described in deleted text begin sectiondeleted text end new text begin sections 256P.06 andnew text end
256J.37, subdivisions 3 to deleted text begin 10deleted text end new text begin 9new text end , received by members of an assistance unit or by other
persons whose income is counted for the assistance unit, described under sections 256J.21
and 256J.37, subdivisions 1 to 2.

This income must be applied to the MFIP standard of need or family wage level subject
to this section and sections 256J.34 to 256J.36. Income received deleted text begin in a calendar monthdeleted text end and
not otherwise excluded under section 256J.21, subdivision 2, must be applied to the needs
of an assistance unit.new text begin An assistance unit is not eligible when the countable income equals
or exceeds the MFIP standard of need or the family wage level for the assistance unit.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 22.

Minnesota Statutes 2020, section 256J.33, subdivision 2, is amended to read:


Subd. 2.

Prospective eligibility.

An agency must determine whether the eligibility
requirements that pertain to an assistance unit, including those in sections 256J.11 to 256J.15
and 256P.02, will be met prospectively for the payment deleted text begin monthdeleted text end new text begin periodnew text end . deleted text begin Except for the
provisions in section 256J.34, subdivision 1,deleted text end The income test will be applied deleted text begin retrospectivelydeleted text end new text begin
prospectivelynew text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 23.

Minnesota Statutes 2020, section 256J.37, subdivision 3, is amended to read:


Subd. 3.

Earned income of wage, salary, and contractual employees.

The agency
must include gross earned income less any disregards in the initial deleted text begin and monthlydeleted text end income
test. Gross earned income received by persons employed on a contractual basis must be
prorated over the period covered by the contract even when payments are received over a
lesser period of time.

new text begin EFFECTIVE DATE. new text end

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

Sec. 24.

Minnesota Statutes 2020, section 256J.37, subdivision 3a, is amended to read:


Subd. 3a.

Rental subsidies; unearned income.

(a) Effective July 1, 2003, the agency
shall count $50 of the value of public and assisted rental subsidies provided through the
Department of Housing and Urban Development (HUD) as unearned income to the cash
portion of the MFIP grant. The full amount of the subsidy must be counted as unearned
income when the subsidy is less than $50. The income from this subsidy shall be budgeted
according to section deleted text begin 256J.34deleted text end new text begin 256P.09new text end .

(b) The provisions of this subdivision shall not apply to an MFIP assistance unit which
includes a participant who is:

(1) age 60 or older;

(2) a caregiver who is suffering from an illness, injury, or incapacity that has been
certified by a qualified professional when the illness, injury, or incapacity is expected to
continue for more than 30 days and severely limits the person's ability to obtain or maintain
suitable employment; or

(3) a caregiver whose presence in the home is required due to the illness or incapacity
of another member in the assistance unit, a relative in the household, or a foster child in the
household when the illness or incapacity and the need for the participant's presence in the
home has been certified by a qualified professional and is expected to continue for more
than 30 days.

(c) The provisions of this subdivision shall not apply to an MFIP assistance unit where
the parental caregiver is an SSI participant.

new text begin EFFECTIVE DATE. new text end

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

Sec. 25.

Minnesota Statutes 2020, section 256J.626, subdivision 1, is amended to read:


Subdivision 1.

Consolidated fund.

The consolidated fund is established to support
counties and tribes in meeting their duties under this chapter. Counties and tribes must use
funds from the consolidated fund to develop programs and services that are designed to
improve participant outcomes as measured in section 256J.751, subdivision 2. Counties new text begin and
tribes that administer MFIP eligibility new text end may use the funds for any allowable expenditures
under subdivision 2, including case management. Tribes new text begin that do not administer MFIP
eligibility new text end may use the funds for any allowable expenditures under subdivision 2, including
case management, except those in subdivision 2, paragraph (a), clauses (1) and (6).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021.
 new text end

Sec. 26.

Minnesota Statutes 2020, section 256N.25, subdivision 2, is amended to read:


Subd. 2.

Negotiation of agreement.

(a) When a child is determined to be eligible for
Northstar kinship assistance or adoption assistance, the financially responsible agency, or,
if there is no financially responsible agency, the agency designated by the commissioner,
must negotiate with the caregiver to develop an agreement under subdivision 1. If and when
the caregiver and agency reach concurrence as to the terms of the agreement, both parties
shall sign the agreement. The agency must submit the agreement, along with the eligibility
determination outlined in sections 256N.22, subdivision 7, and 256N.23, subdivision 7, to
the commissioner for final review, approval, and signature according to subdivision 1.

(b) A monthly payment is provided as part of the adoption assistance or Northstar kinship
assistance agreement to support the care of children unless the child is eligible for adoption
assistance and determined to be an at-risk child, in which case no payment will be made
unless and until the caregiver obtains written documentation from a qualified expert that
the potential disability upon which eligibility for the agreement was based has manifested
itself.

(1) The amount of the payment made on behalf of a child eligible for Northstar kinship
assistance or adoption assistance is determined through agreement between the prospective
relative custodian or the adoptive parent and the financially responsible agency, or, if there
is no financially responsible agency, the agency designated by the commissioner, using the
assessment tool established by the commissioner in section 256N.24, subdivision 2, and the
associated benefit and payments outlined in section 256N.26. Except as provided under
section 256N.24, subdivision 1, paragraph (c), the assessment tool establishes the monthly
benefit level for a child under foster care. The monthly payment under a Northstar kinship
assistance agreement or adoption assistance agreement may be negotiated up to the monthly
benefit level under foster care. In no case may the amount of the payment under a Northstar
kinship assistance agreement or adoption assistance agreement exceed the foster care
maintenance payment which would have been paid during the month if the child with respect
to whom the Northstar kinship assistance or adoption assistance payment is made had been
in a foster family home in the state.

(2) The rate schedule for the agreement is determined based on the age of the child on
the date that the prospective adoptive parent or parents or relative custodian or custodians
sign the agreement.

(3) The income of the relative custodian or custodians or adoptive parent or parents must
not be taken into consideration when determining eligibility for Northstar kinship assistance
or adoption assistance or the amount of the payments under section 256N.26.

(4) With the concurrence of the relative custodian or adoptive parent, the amount of the
payment may be adjusted periodically using the assessment tool established by the
commissioner in section 256N.24, subdivision 2, and the agreement renegotiated under
subdivision 3 when there is a change in the child's needs or the family's circumstances.

(5) An adoptive parent of an at-risk child with an adoption assistance agreement may
request a reassessment of the child under section 256N.24, subdivision 10, and renegotiation
of the adoption assistance agreement under subdivision 3 to include a monthly payment, if
the caregiver has written documentation from a qualified expert that the potential disability
upon which eligibility for the agreement was based has manifested itself. Documentation
of the disability must be limited to evidence deemed appropriate by the commissioner.

(c) For Northstar kinship assistance agreements:

(1) the initial amount of the monthly Northstar kinship assistance payment must be
equivalent to the foster care rate in effect at the time that the agreement is signed deleted text begin less any
offsets under section 256N.26, subdivision 11deleted text end , or a lesser negotiated amount if agreed to
by the prospective relative custodian and specified in that agreement, unless the Northstar
kinship assistance agreement is entered into when a child is under the age of six; and

(2) the amount of the monthly payment for a Northstar kinship assistance agreement for
a child who is under the age of six must be as specified in section 256N.26, subdivision 5.

(d) For adoption assistance agreements:

(1) for a child in foster care with the prospective adoptive parent immediately prior to
adoptive placement, the initial amount of the monthly adoption assistance payment must
be equivalent to the foster care rate in effect at the time that the agreement is signed deleted text begin less
any offsets in section 256N.26, subdivision 11deleted text end , or a lesser negotiated amount if agreed to
by the prospective adoptive parents and specified in that agreement, unless the child is
identified as at-risk or the adoption assistance agreement is entered into when a child is
under the age of six;

(2) for an at-risk child who must be assigned level A as outlined in section 256N.26, no
payment will be made unless and until the potential disability manifests itself, as documented
by an appropriate professional, and the commissioner authorizes commencement of payment
by modifying the agreement accordingly;

(3) the amount of the monthly payment for an adoption assistance agreement for a child
under the age of six, other than an at-risk child, must be as specified in section 256N.26,
subdivision 5;

(4) for a child who is in the Northstar kinship assistance program immediately prior to
adoptive placement, the initial amount of the adoption assistance payment must be equivalent
to the Northstar kinship assistance payment in effect at the time that the adoption assistance
agreement is signed or a lesser amount if agreed to by the prospective adoptive parent and
specified in that agreement, unless the child is identified as an at-risk child; and

(5) for a child who is not in foster care placement or the Northstar kinship assistance
program immediately prior to adoptive placement or negotiation of the adoption assistance
agreement, the initial amount of the adoption assistance agreement must be determined
using the assessment tool and process in this section and the corresponding payment amount
outlined in section 256N.26.

Sec. 27.

Minnesota Statutes 2020, section 256N.25, subdivision 3, is amended to read:


Subd. 3.

Renegotiation of agreement.

(a) A relative custodian or adoptive parent of a
child with a Northstar kinship assistance or adoption assistance agreement may request
renegotiation of the agreement when there is a change in the needs of the child or in the
family's circumstances. When a relative custodian or adoptive parent requests renegotiation
of the agreement, a reassessment of the child must be completed consistent with section
256N.24, subdivisions 10 and 11. If the reassessment indicates that the child's level has
changed, the financially responsible agency or, if there is no financially responsible agency,
the agency designated by the commissioner or the commissioner's designee, and the caregiver
must renegotiate the agreement to include a payment with the level determined through the
reassessment process. The agreement must not be renegotiated unless the commissioner,
the financially responsible agency, and the caregiver mutually agree to the changes. The
effective date of any renegotiated agreement must be determined by the commissioner.

(b) An adoptive parent of an at-risk child with an adoption assistance agreement may
request renegotiation of the agreement to include a monthly payment under section 256N.26
if the caregiver has written documentation from a qualified expert that the potential disability
upon which eligibility for the agreement was based has manifested itself. Documentation
of the disability must be limited to evidence deemed appropriate by the commissioner. Prior
to renegotiating the agreement, a reassessment of the child must be conducted as outlined
in section 256N.24, subdivision 10. The reassessment must be used to renegotiate the
agreement to include an appropriate monthly payment. The agreement must not be
renegotiated unless the commissioner, the financially responsible agency, and the caregiver
mutually agree to the changes. The effective date of any renegotiated agreement must be
determined by the commissioner.

deleted text begin (c) Renegotiation of a Northstar kinship assistance or adoption assistance agreement is
required when one of the circumstances outlined in section 256N.26, subdivision 13, occurs.
 deleted text end

Sec. 28.

Minnesota Statutes 2020, section 256N.26, subdivision 11, is amended to read:


Subd. 11.

Child income or income attributable to the child.

(a) A monthly Northstar
kinship assistance or adoption assistance payment must be considered as income and
resources attributable to the child. Northstar kinship assistance and adoption assistance are
exempt from garnishment, except as permissible under the laws of the state where the child
resides.

(b) When a child is placed into foster care, any income and resources attributable to the
child are treated as provided in sections 252.27 and 260C.331, or 260B.331, as applicable
to the child being placed.

(c) deleted text begin Consideration of income and resources attributable to the child must be part of the
negotiation process outlined in section 256N.25, subdivision 2. In some circumstances, the
receipt of other income on behalf of the child may impact the amount of the monthly payment
received by the relative custodian or adoptive parent on behalf of the child through Northstar
Care for Children.deleted text end Supplemental Security Income (SSI), retirement survivor's disability
insurance (RSDI), veteran's benefits, railroad retirement benefits, and black lung benefits
are considered income and resources attributable to the child.

Sec. 29.

Minnesota Statutes 2020, section 256N.26, subdivision 13, is amended to read:


Subd. 13.

Treatment of retirement survivor's disability insurance, veteran's benefits,
railroad retirement benefits, and black lung benefits.

deleted text begin (a)deleted text end If a child placed in foster care
receives retirement survivor's disability insurance, veteran's benefits, railroad retirement
benefits, or black lung benefits at the time of foster care placement or subsequent to
placement in foster care, the financially responsible agency may apply to be the payee for
the child for the duration of the child's placement in foster care. If it is anticipated that a
child will be eligible to receive retirement survivor's disability insurance, veteran's benefits,
railroad retirement benefits, or black lung benefits after finalization of the adoption or
assignment of permanent legal and physical custody, the permanent caregiver shall apply
to be the payee of those benefits on the child's behalf. deleted text begin The monthly amount of the other
benefits must be considered an offset to the amount of the payment the child is determined
eligible for under Northstar Care for Children.
deleted text end

deleted text begin (b) If a child becomes eligible for retirement survivor's disability insurance, veteran's
benefits, railroad retirement benefits, or black lung benefits, after the initial amount of the
payment under Northstar Care for Children is finalized, the permanent caregiver shall contact
the commissioner to redetermine the payment under Northstar Care for Children. The
monthly amount of the other benefits must be considered an offset to the amount of the
payment the child is determined eligible for under Northstar Care for Children.
 deleted text end

deleted text begin (c) If a child ceases to be eligible for retirement survivor's disability insurance, veteran's
benefits, railroad retirement benefits, or black lung benefits after the initial amount of the
payment under Northstar Care for Children is finalized, the permanent caregiver shall contact
the commissioner to redetermine the payment under Northstar Care for Children. The
monthly amount of the payment under Northstar Care for Children must be the amount the
child was determined to be eligible for prior to consideration of any offset.
 deleted text end

deleted text begin (d) If the monthly payment received on behalf of the child under retirement survivor's
disability insurance, veteran's benefits, railroad retirement benefits, or black lung benefits
changes after the adoption assistance or Northstar kinship assistance agreement is finalized,
the permanent caregiver shall notify the commissioner as to the new monthly payment
amount, regardless of the amount of the change in payment. If the monthly payment changes
by $75 or more, even if the change occurs incrementally over the duration of the term of
the adoption assistance or Northstar kinship assistance agreement, the monthly payment
under Northstar Care for Children must be adjusted without further consent to reflect the
amount of the increase or decrease in the offset amount. Any subsequent change to the
payment must be reported and handled in the same manner. A change of monthly payments
of less than $75 is not a permissible reason to renegotiate the adoption assistance or Northstar
kinship assistance agreement under section 256N.25, subdivision 3. The commissioner shall
review and revise the limit at which the adoption assistance or Northstar kinship assistance
agreement must be renegotiated in accordance with subdivision 9.
 deleted text end

Sec. 30.

Minnesota Statutes 2020, section 256P.01, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Prospective budgeting. new text end

new text begin "Prospective budgeting" means estimating the amount
of monthly income that an assistance unit will have in the payment month.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 31.

Minnesota Statutes 2020, section 256P.04, subdivision 4, is amended to read:


Subd. 4.

Factors to be verified.

(a) The agency shall verify the following at application:

(1) identity of adults;

(2) age, if necessary to determine eligibility;

(3) immigration status;

(4) income;

(5) spousal support and child support payments made to persons outside the household;

(6) vehicles;

(7) checking and savings accounts;

(8) inconsistent information, if related to eligibility;

(9) residence;new text begin and
new text end

(10) Social Security numberdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (11) use of nonrecurring income under section 256P.06, subdivision 3, clause (2), item
(ix), for the intended purpose for which it was given and received.
 deleted text end

(b) Applicants who are qualified noncitizens and victims of domestic violence as defined
under section 256J.08, subdivision 73, clause (7), are not required to verify the information
in paragraph (a), clause (10). When a Social Security number is not provided to the agency
for verification, this requirement is satisfied when each member of the assistance unit
cooperates with the procedures for verification of Social Security numbers, issuance of
duplicate cards, and issuance of new numbers which have been established jointly between
the Social Security Administration and the commissioner.

new text begin EFFECTIVE DATE. new text end

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

Sec. 32.

Minnesota Statutes 2020, section 256P.04, subdivision 8, is amended to read:


Subd. 8.

Recertification.

The agency shall recertify eligibility deleted text begin in an annual interview
with the participant. The interview may be conducted by telephone, by Internet telepresence,
or face-to-face in the county office or in another location mutually agreed upon. A participant
must be given the option of a telephone interview or Internet telepresence to recertify
eligibilitydeleted text end new text begin annuallynew text end . During deleted text begin the interviewdeleted text end new text begin recertification and reporting under section 256P.10new text end ,
the agency shall verify the following:

(1) income, unless excluded, including self-employment earnings;

(2) assets when the value is within $200 of the asset limit; and

(3) inconsistent information, if related to eligibility.

new text begin EFFECTIVE DATE. new text end

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

Sec. 33.

Minnesota Statutes 2020, section 256P.06, subdivision 3, is amended to read:


Subd. 3.

Income inclusions.

The following must be included in determining the income
of an assistance unit:

(1) earned income; and

(2) unearned income, which includes:

(i) interest and dividends from investments and savings;

(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;

(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;

(iv) income from trusts, excluding special needs and supplemental needs trusts;

(v) interest income from loans made by the participant or household;

(vi) cash prizes and winningsnew text begin according to guidance provided for the Supplemental
Nutrition Assistance Programnew text end ;

(vii) unemployment insurance incomenew text begin that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
new text end

new text begin (A) 18 years of age and enrolled in a secondary school; or
 new text end

new text begin (B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-timenew text end ;

(viii) retirement, survivors, and disability insurance payments;

deleted text begin (ix) nonrecurring income over $60 per quarter unless earmarked and used for the purpose
for which it is intended. Income and use of this income is subject to verification requirements
under section 256P.04;
 deleted text end

deleted text begin (x)deleted text end new text begin (ix)new text end retirement benefits;

deleted text begin (xi)deleted text end new text begin (x)new text end cash assistance benefits, as defined by each program in chapters 119B, 256D,
256I, and 256J;

deleted text begin (xii)deleted text end new text begin (xi)new text end tribal per capita payments unless excluded by federal and state law;

deleted text begin (xiii)deleted text end new text begin (xii)new text end income and payments from service and rehabilitation programs that meet or
exceed the state's minimum wage rate;

deleted text begin (xiv)deleted text end new text begin (xiii)new text end income from members of the United States armed forces unless excluded
from income taxes according to federal or state law;

deleted text begin (xv)deleted text end new text begin (xiv)new text end all child support payments for programs under chapters 119B, 256D, and 256I;

deleted text begin (xvi)deleted text end new text begin (xv)new text end the amount of child support received that exceeds $100 for assistance units
with one child and $200 for assistance units with two or more children for programs under
chapter 256J; and

deleted text begin (xvii)deleted text end new text begin (xvi)new text end spousal support.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2023, except subdivision 3,
paragraph (2), clause (vii), which is effective the day following final enactment.
 new text end

Sec. 34.

Minnesota Statutes 2020, section 256P.07, is amended to read:


256P.07 REPORTING OF deleted text begin INCOME ANDdeleted text end CHANGES.

Subdivision 1.

Exempted programs.

Participants who new text begin receive Supplemental Security
Income and new text end qualify for Minnesota supplemental aid under chapter 256D deleted text begin anddeleted text end new text begin ornew text end for housing
support under chapter 256I deleted text begin on the basis of eligibility for Supplemental Security Incomedeleted text end are
exempt from deleted text begin this sectiondeleted text end new text begin reporting incomenew text end .

new text begin Subd. 1a. new text end

new text begin Child care assistance programs. new text end

new text begin Participants who qualify for child care
assistance programs under chapter 119B are exempt from this section except for the reporting
requirements in subdivision 6.
 new text end

Subd. 2.

Reporting requirements.

An applicant or participant must provide information
on an application and any subsequent reporting forms about the assistance unit's
circumstances that affect eligibility or benefits. An applicant or assistance unit must report
changes identified in deleted text begin subdivisiondeleted text end new text begin subdivisionsnew text end 3new text begin , 4, 5, 7, 8, and 9 during the application
period or by the tenth of the month following the month that the change occurrednew text end . When
information is not accurately reported, both an overpayment and a referral for a fraud
investigation may result. When information or documentation is not provided, the receipt
of any benefit may be delayed or denied, depending on the type of information required
and its effect on eligibility.

Subd. 3.

Changes that must be reported.

deleted text begin An assistance unit must report the changes
or anticipated changes specified in clauses (1) to (12) within ten days of the date they occur,
at the time of recertification of eligibility under section 256P.04, subdivisions 8 and 9, or
within eight calendar days of a reporting period, whichever occurs first. An assistance unit
must report other changes at the time of recertification of eligibility under section 256P.04,
subdivisions 8 and 9, or at the end of a reporting period, as applicable. When an agency
could have reduced or terminated assistance for one or more payment months if a delay in
reporting a change specified under clauses (1) to (12) had not occurred, the agency must
determine whether a timely notice could have been issued on the day that the change
occurred. When a timely notice could have been issued, each month's overpayment
subsequent to that notice must be considered a client error overpayment under section
119B.11, subdivision 2a, or 256P.08. Changes in circumstances that must be reported within
ten days must also be reported for the reporting period in which those changes occurred.
Within ten days, an assistance unit must report:
 deleted text end

deleted text begin (1) a change in earned income of $100 per month or greater with the exception of a
program under chapter 119B;
 deleted text end

deleted text begin (2) a change in unearned income of $50 per month or greater with the exception of a
program under chapter 119B;
 deleted text end

deleted text begin (3) a change in employment status and hours with the exception of a program under
chapter 119B;
 deleted text end

deleted text begin (4) a change in address or residence;
 deleted text end

deleted text begin (5) a change in household composition with the exception of programs under chapter
256I;
 deleted text end

deleted text begin (6) a receipt of a lump-sum payment with the exception of a program under chapter
119B;
 deleted text end

deleted text begin (7) an increase in assets if over $9,000 with the exception of programs under chapter
119B;
 deleted text end

deleted text begin (8) a change in citizenship or immigration status;
 deleted text end

deleted text begin (9) a change in family status with the exception of programs under chapter 256I;
 deleted text end

deleted text begin (10) a change in disability status of a unit member, with the exception of programs under
chapter 119B;
 deleted text end

deleted text begin (11) a new rent subsidy or a change in rent subsidy with the exception of a program
under chapter 119B; and
 deleted text end

deleted text begin (12) a sale, purchase, or transfer of real property with the exception of a program under
chapter 119B. deleted text end new text begin An assistance unit must report changes or anticipated changes as described
in this section.
 new text end

new text begin (a) An assistance unit must report:
 new text end

new text begin (1) a change in eligibility for Supplemental Security Income, Retirement Survivors
Disability Insurance, or another federal income support;
 new text end

new text begin (2) a change in address or residence;
 new text end

new text begin (3) a change in household composition with the exception of programs under chapter
256I;
 new text end

new text begin (4) cash prizes and winnings according to guidance provided for the Supplemental
Nutrition Assistance Program;
 new text end

new text begin (5) a change in citizenship or immigration status;
 new text end

new text begin (6) a change in family status with the exception of programs under chapter 256I; and
 new text end

new text begin (7) assets when the value is at or above the asset limit.
 new text end

new text begin (b) When an agency could have reduced or terminated assistance for one or more payment
months if a delay in reporting a change specified in clauses (1) to (7) had not occurred, the
agency must determine whether a timely notice could have been issued on the day that the
change occurred. When a timely notice could have been issued, each month's overpayment
subsequent to the notice must be considered a client error overpayment under section
256P.08.
 new text end

Subd. 4.

MFIP-specific reporting.

In addition to subdivision 3, an assistance unit under
chapter 256J, deleted text begin within ten days of the change,deleted text end must report:

(1) a pregnancy not resulting in birth when there are no other minor children; deleted text begin and
deleted text end

(2) a change in school attendance of a parent under 20 years of age deleted text begin or of an employed
child.deleted text end new text begin ; and
new text end

new text begin (3) an individual who is 18 or 19 years of age attending high school who graduates or
drops out of school.
 new text end

Subd. 5.

DWP-specific reporting.

In addition to subdivisions 3 and 4, an assistance
unit participating in the diversionary work program under section 256J.95 must report on
an application:

(1) shelter expenses; and

(2) utility expenses.

Subd. 6.

Child care assistance programs-specific reporting.

(a) deleted text begin In addition to
subdivision 3,deleted text end An assistance unit under chapter 119B, within ten days of the change, must
report:

(1) a change in a parentally responsible individual's custody schedule for any child
receiving child care assistance program benefits;

(2) a permanent end in a parentally responsible individual's authorized activity; deleted text begin and
deleted text end

(3) if the unit's family's annual included income exceeds 85 percent of the state median
income, adjusted for family sizedeleted text begin .deleted text end new text begin ;
new text end

new text begin (4) a change in address or residence;
 new text end

new text begin (5) a change in household composition;
 new text end

new text begin (6) a change in citizenship or immigration status; and
 new text end

new text begin (7) a change in family status.
 new text end

(b) An assistance unit subject to section 119B.095, subdivision 1, paragraph (b), must
report a change in the unit's authorized activity status.

(c) An assistance unit must notify the county when the unit wants to reduce the number
of authorized hours for children in the unit.

Subd. 7.

Minnesota supplemental aid-specific reporting.

new text begin (a) new text end In addition to subdivision
3new text begin and notwithstanding the exemption in subdivision 1new text end , an assistance unit participating in
the Minnesota supplemental aid program under deleted text begin section 256D.44, subdivision 5, paragraph
(g), within ten days of the change,deleted text end new text begin chapter 256Dnew text end must report deleted text begin shelter expenses.deleted text end new text begin :
new text end

new text begin (1) a change in unearned income of $50 per month or greater; and
 new text end

new text begin (2) a change in earned income of $100 per month or greater.
 new text end

new text begin (b) An assistance unit receiving housing assistance under section 256D.44, subdivision
5, paragraph (g), including assistance units who also receive Supplemental Security Income,
must report:
 new text end

new text begin (1) a change in shelter expenses; and
 new text end

new text begin (2) a new rent subsidy or a change in a rent subsidy.
 new text end

new text begin Subd. 8. new text end

new text begin Housing support-specific reporting. new text end

new text begin (a) In addition to subdivision 3, an
assistance unit participating in the housing support program under chapter 256I must report:
 new text end

new text begin (1) a change in unearned income of $50 per month or greater; and
 new text end

new text begin (2) a change in earned income of $100 per month or greater, with the exception of
participants already subject to six-month reporting requirements in section 256P.10.
 new text end

new text begin (b) Notwithstanding the exemptions in subdivisions 1 and 3, an assistance unit receiving
housing support under chapter 256I, including an assistance unit that receives Supplemental
Security Income, must report:
 new text end

new text begin (1) a new rent subsidy or a change in a rent subsidy;
 new text end

new text begin (2) a change in the disability status of a unit member; and
 new text end

new text begin (3) a change in household composition if the assistance unit is a participant in housing
support under section 256I.04, subdivision 3, paragraph (a), clause (3).
 new text end

new text begin Subd. 9. new text end

new text begin General assistance-specific reporting. new text end

new text begin In addition to subdivision 3, an
assistance unit participating in the general assistance program under chapter 256D must
report:
 new text end

new text begin (1) a change in unearned income of $50 per month or greater;
 new text end

new text begin (2) a change in earned income of $100 per month or greater, with the exception of
participants who are already subject to six-month reporting requirements in section 256P.10;
and
 new text end

new text begin (3) changes in any condition that would result in the loss of a basis for eligibility in
section 256D.05, subdivision 1, paragraph (a).
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 35.

new text begin [256P.09] PROSPECTIVE BUDGETING OF BENEFITS.
 new text end

new text begin Subdivision 1. new text end

new text begin Exempted programs. new text end

new text begin Assistance units who qualify for child care
assistance programs under chapter 119B; housing support assistance units under chapter
256I who are not subject to reporting under section 256P.10; and assistance units who
qualify for Minnesota Supplemental Aid under chapter 256D are exempt from this section.
 new text end

new text begin Subd. 2. new text end

new text begin Prospective budgeting of benefits. new text end

new text begin An agency must use prospective budgeting
to calculate an assistance payment amount.
 new text end

new text begin Subd. 3. new text end

new text begin Income changes. new text end

new text begin Prospective budgeting must be used to determine the amount
of the assistance unit's benefit for the following six-month period. An increase in income
shall not affect an assistance unit's eligibility or benefit amount until the next case review
unless otherwise required by section 256P.07. A decrease in income shall be effective on
the date that the change occurs.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 36.

new text begin [256P.10] SIX-MONTH REPORTING.
 new text end

new text begin Subdivision 1. new text end

new text begin Exempted programs. new text end

new text begin Assistance units who qualify for child care
assistance programs under chapter 119B; assistance units who qualify for Minnesota
Supplemental Aid under chapter 256D; and assistance units who qualify for housing support
under chapter 256I and also receive Supplemental Security Income are exempt from this
section.
 new text end

new text begin Subd. 2. new text end

new text begin Reporting. new text end

new text begin (a) Every six months, an assistance unit that qualifies for the
Minnesota family investment program under chapter 256J; an assistance unit that qualifies
for general assistance under chapter 256D with earned income of $100 per month or greater;
or an assistance unit that qualifies for housing support under chapter 256I with earned
income of $100 per month or greater is subject to six month case reviews. The initial
reporting period may be shorter than six months in order to align with other program reporting
periods.
 new text end

new text begin (b) An assistance unit that qualifies for the Minnesota family investment program and
an assistance unit that qualifies for general assistance as described in paragraph (a) must
complete household report forms as prescribed by the commissioner for redetermination of
benefits.
 new text end

new text begin (c) An assistance unit that qualifies for housing support as described in paragraph (a)
must complete household report forms as prescribed by the commissioner to provide
information about earned income.
 new text end

new text begin (d) An assistance unit that qualifies for housing support and also receives assistance
through the Minnesota family investment program shall be subject to the requirements of
this section for purposes of the Minnesota family investment program but not for housing
support.
 new text end

new text begin (e) An assistance unit must submit a household report form in compliance with the
provisions in section 256P.04, subdivision 11.
 new text end

new text begin (f) An assistance unit may choose to report changes under this section at any time.
 new text end

new text begin Subd. 3. new text end

new text begin When to terminate assistance. new text end

new text begin (a) An agency must end benefits when the
participant fails to submit the household report form before the end of the six month review
period. If the participant submits the household report form within 30 days of the termination
of benefits, benefits must be reinstated and made available retroactively for the full benefit
month.
 new text end

new text begin (b) When an assistance unit is determined to be ineligible for assistance according to
this section and chapter 256D, 256I, or 256J, the agency must terminate assistance
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 37. new text begin DIRECTION TO THE COMMISSIONER; CHILD CARE AND
DEVELOPMENT BLOCK GRANT ALLOCATION.
new text end

new text begin (a) The commissioner shall allocate $10,948,000 in fiscal year 2022, $36,571,000 in
fiscal year 2023, $35,522,000 in fiscal year 2024, and $49,710,000 in fiscal year 2025 from
the child care development block grant amount in the federal fund for the rate increase under
Minnesota Statutes, section 119B.13, subdivision 1, paragraph (a).
 new text end

new text begin (b) Each year an amount equal to at least 88 percent of the federal discretionary funding
in the Child Care Development Block Grant of 2014, Public Law 113-186, in federal fiscal
year 2018 above the amounts authorized in federal fiscal year 2017 shall be allocated to
pay the cost of rate adjustments based on the most recent market survey.
 new text end

new text begin (c) When increased federal discretionary child care development block grant funding is
used to pay for the rate increase under paragraph (a), the commissioner, in consultation with
the commissioner of management and budget, may adjust the amount of working family
credit expenditures as needed to meet the state's maintenance of effort requirements for the
TANF block grant.
 new text end

Sec. 38. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2020, sections 256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b,
6c, 7, 8, 9, and 18; and 256D.052, subdivision 3, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2020, sections 256J.08, subdivisions 10, 53, 61, 62, 81, and 83;
256J.30, subdivisions 5, 7, and 8; 256J.33, subdivisions 3, 4, and 5; 256J.34, subdivisions
1, 2, 3, and 4; and 256J.37, subdivision 10, new text end new text begin are repealed.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective August 1, 2021. Paragraph (b) is effective
March 1, 2023.
 new text end

ARTICLE 2

COMMUNITY SUPPORTS

Section 1.

Minnesota Statutes 2020, section 245A.03, subdivision 7, is amended to read:


Subd. 7.

Licensing moratorium.

(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. When approving an exception under this paragraph,
the commissioner shall consider the resource need determination process in paragraph (h),
the availability of foster care licensed beds in the geographic area in which the licensee
seeks to operate, the results of a person's choices during their annual assessment and service
plan review, and the recommendation of the local county board. The determination by the
commissioner is final and not subject to appeal. Exceptions to the moratorium include:

(1) foster care settings that are required to be registered under chapter 144D;

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);

(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;

(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
deleted text begin or
deleted text end

(5) new foster care licenses or community residential setting licenses for people receiving
services under chapter 245D and residing in an unlicensed setting before May 1, 2017, and
for which a license is required. This exception does not apply to people living in their own
home. For purposes of this clause, there is a presumption that a foster care or community
residential setting license is required for services provided to three or more people in a
dwelling unit when the setting is controlled by the provider. A license holder subject to this
exception may rebut the presumption that a license is required by seeking a reconsideration
of the commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until June 30, 2018. This exception is available when:

(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and

(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agencydeleted text begin .deleted text end new text begin ; or
new text end

new text begin (6) new foster care licenses or community residential setting licenses for people receiving
customized living or 24-hour customized living services under the brain injury or community
access for disability inclusion waiver plans under section 256B.49 and residing in the
customized living setting before July 1, 2022, for which a license is required. A customized
living service provider subject to this exception may rebut the presumption that a license
is required by seeking a reconsideration of the commissioner's determination. The
commissioner's disposition of a request for reconsideration is final and not subject to appeal
under chapter 14. The exception is available until June 30, 2023. This exception is available
when:
 new text end

new text begin (i) the person's customized living services are provided in a customized living service
setting serving four or fewer people under the brain injury or community access for disability
inclusion waiver plans under section 256B.49 in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;
 new text end

new text begin (ii) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
 new text end

new text begin (iii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the customized
living setting as determined by the lead agency.
 new text end

(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.

(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department may decrease
the statewide licensed capacity for adult foster care settings.

(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.

(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity determined under section 256B.493 will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet the
informed decisions of those people who want to move out of corporate foster care or
community residential settings, long-term service needs within budgetary limits, including
seeking proposals from service providers or lead agencies to change service type, capacity,
or location to improve services, increase the independence of residents, and better meet
needs identified by the long-term services and supports reports and statewide data and
information.

(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.

(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human
services licensing division that the license holder provides or intends to provide these
waiver-funded services.

(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493. Annually, by August 1, the commissioner shall provide
information and data on capacity of licensed long-term services and supports, actions taken
under the subdivision to manage statewide long-term services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over the
health and human services budget.

(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.

(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2022.
 new text end

Sec. 2.

Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision to
read:


new text begin Subd. 15. new text end

new text begin Early intensive developmental and behavioral intervention providers. new text end

new text begin The
commissioner shall conduct background studies according to this chapter when initiated by
an early intensive developmental and behavioral intervention provider under section
256B.0949.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision to
read:


new text begin Subd. 17. new text end

new text begin Early intensive developmental and behavioral intervention providers. new text end

new text begin The
commissioner shall recover the cost of background studies required under section 245C.03,
subdivision 15, for the purposes of early intensive developmental and behavioral intervention
under section 256B.0949, through a fee of no more than $20 per study charged to the enrolled
agency. The fees collected under this subdivision are appropriated to the commissioner for
the purpose of conducting background studies.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2020, 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) care 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) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;

(7) medication-assisted therapy 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 which
provide, respectively, 30, 15, and five hours of clinical services each week;

(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, which 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.

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

deleted text begin (1) programs that serve parents with their children if the program:
 deleted text end

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

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

deleted text begin (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
 deleted text end

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

deleted text begin (A) a child care center under Minnesota Rules, chapter deleted text end deleted text begin 9503 deleted text end deleted text begin ; or
 deleted text end

deleted text begin (B) a family child care home under Minnesota Rules, chapter deleted text end deleted text begin 9502 deleted text end deleted text begin ;
 deleted text end

deleted text begin (2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
 deleted text end

deleted text begin (i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
 deleted text end

deleted text begin (ii) is governed with significant input from individuals of that specific background; and
 deleted text end

deleted text begin (iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
 deleted text end

deleted text begin (3) 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; and
 deleted text end

deleted text begin (4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
 deleted text end

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

deleted text begin (ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, 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

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

deleted text begin (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;
 deleted text end

deleted text begin (v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
 deleted text end

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

deleted text begin (d) In order 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 chemical dependency 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.
 deleted text end

deleted text begin (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).
 deleted text end

deleted text begin (f)deleted text end new text begin (e) new text end Subject to federal approval, deleted text begin chemical dependencydeleted text end new text begin substance use disorder new text end services
that are otherwise covered as direct face-to-face services may be provided via two-way
interactive videonew text begin according to section 256B.0625, subdivision 3bnew text end . deleted text begin The use of two-way
interactive video 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. The interactive video equipment and
connection must comply with Medicare standards in effect at the time the service is provided.
deleted text end

deleted text begin (g)deleted text end new text begin (f)new text end 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.

new text begin (g) 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.
 new text end

Sec. 5.

Minnesota Statutes 2020, section 256.042, subdivision 2, is amended to read:


Subd. 2.

Membership.

(a) The council shall consist of the following deleted text begin 19deleted text end new text begin 28new text end voting
members, appointed by the commissioner of human services except as otherwise specified,
and three nonvoting members:

(1) two members of the house of representatives, appointed in the following sequence:
the first from the majority party appointed by the speaker of the house and the second from
the minority party appointed by the minority leader. Of these two members, one member
must represent a district outside of the seven-county metropolitan area, and one member
must represent a district that includes the seven-county metropolitan area. The appointment
by the minority leader must ensure that this requirement for geographic diversity in
appointments is met;

(2) two members of the senate, appointed in the following sequence: the first from the
majority party appointed by the senate majority leader and the second from the minority
party appointed by the senate minority leader. Of these two members, one member must
represent a district outside of the seven-county metropolitan area and one member must
represent a district that includes the seven-county metropolitan area. The appointment by
the minority leader must ensure that this requirement for geographic diversity in appointments
is met;

(3) one member appointed by the Board of Pharmacy;

(4) one member who is a physician appointed by the Minnesota Medical Association;

(5) one member representing opioid treatment programs, sober living programs, or
substance use disorder programs licensed under chapter 245G;

(6) one member appointed by the Minnesota Society of Addiction Medicine who is an
addiction psychiatrist;

(7) one member representing professionals providing alternative pain management
therapies, including, but not limited to, acupuncture, chiropractic, or massage therapy;

(8) one member representing nonprofit organizations conducting initiatives to address
the opioid epidemic, with the commissioner's initial appointment being a member
representing the Steve Rummler Hope Network, and subsequent appointments representing
this or other organizations;

(9) one member appointed by the Minnesota Ambulance Association who is serving
with an ambulance service as an emergency medical technician, advanced emergency
medical technician, or paramedic;

(10) one member representing the Minnesota courts who is a judge or law enforcement
officer;

(11) one public member who is a Minnesota resident and who is in opioid addiction
recovery;

(12) deleted text begin twodeleted text end new text begin 11new text end members representing Indian tribes, one representing deleted text begin the Ojibwe tribes and
one representing the Dakota tribesdeleted text end new text begin each of Minnesota's tribal nationsnew text end ;

(13) one public member who is a Minnesota resident and who is suffering from chronic
pain, intractable pain, or a rare disease or condition;

(14) one mental health advocate representing persons with mental illness;

(15) one member appointed by the Minnesota Hospital Association;

(16) one member representing a local health department; and

(17) the commissioners of human services, health, and corrections, or their designees,
who shall be ex officio nonvoting members of the council.

(b) The commissioner of human services shall coordinate the commissioner's
appointments to provide geographic, racial, and gender diversity, and shall ensure that at
least one-half of council members appointed by the commissioner reside outside of the
seven-county metropolitan area. Of the members appointed by the commissioner, to the
extent practicable, at least one member must represent a community of color
disproportionately affected by the opioid epidemic.

(c) The council is governed by section 15.059, except that members of the council shall
serve three-year terms and shall receive no compensation other than reimbursement for
expenses. Notwithstanding section 15.059, subdivision 6, the council shall not expire.

(d) The chair shall convene the council at least quarterly, and may convene other meetings
as necessary. The chair shall convene meetings at different locations in the state to provide
geographic access, and shall ensure that at least one-half of the meetings are held at locations
outside of the seven-county metropolitan area.

(e) The commissioner of human services shall provide staff and administrative services
for the advisory council.

(f) The council is subject to chapter 13D.

Sec. 6.

Minnesota Statutes 2020, section 256.042, subdivision 4, is amended to read:


Subd. 4.

Grants.

(a) The commissioner of human services shall submit a report of the
grants proposed by the advisory council to be awarded for the upcoming deleted text begin fiscaldeleted text end new text begin calendarnew text end
year to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance, by March 1 of each year,
beginning March 1, 2020.

(b) The commissioner of human services shall award grants from the opiate epidemic
response fund under section 256.043. The grants shall be awarded to proposals selected by
the advisory council that address the priorities in subdivision 1, paragraph (a), clauses (1)
to (4), unless otherwise appropriated by the legislature. No more than three percent of the
grant amount may be used by a grantee for administration.

Sec. 7.

Minnesota Statutes 2020, section 256.043, subdivision 3, is amended to read:


Subd. 3.

Appropriations from fund.

(a) After the appropriations in Laws 2019, chapter
63, article 3, section 1, paragraphs (e), (f), (g), and (h) are made, $249,000 is appropriated
to the commissioner of human services for the provision of administrative services to the
Opiate Epidemic Response Advisory Council and for the administration of the grants awarded
under paragraph (e).

(b) $126,000 is appropriated to the Board of Pharmacy for the collection of the registration
fees under section 151.066.

(c) $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.

(d) After the appropriations in paragraphs (a) to (c) are made, 50 percent of the remaining
amount is appropriated to the commissioner of human services for distribution to county
social service and tribal social service agencies to provide child protection services to
children and families who are affected by addiction. The commissioner shall distribute this
money proportionally to counties and tribal social service agencies based on out-of-home
placement episodes where parental drug abuse is the primary reason for the out-of-home
placement using data from the previous calendar year. County and tribal social service
agencies receiving funds from the opiate epidemic response fund must annually report to
the commissioner on how the funds were used to provide child protection services, including
measurable outcomes, as determined by the commissioner. County social service agencies
and tribal social service agencies must not use funds received under this paragraph to supplant
current state or local funding received for child protection services for children and families
who are affected by addiction.

(e) After making the appropriations in paragraphs (a) to (d), the remaining amount in
the fund is appropriated to the commissioner to award grants as specified by the Opiate
Epidemic Response Advisory Council in accordance with section 256.042, unless otherwise
appropriated by the legislature.

new text begin (f) Beginning in fiscal year 2022 and each year thereafter, funds for county social service
and tribal social service agencies under paragraph (d) and grant funds specified by the Opiate
Epidemic Response Advisory Council under paragraph (e) shall be distributed on a calendar
year basis.
 new text end

Sec. 8.

Minnesota Statutes 2020, section 256B.0625, subdivision 20, is amended to read:


Subd. 20.

Mental health case management.

(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.

(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.

(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:

(1) at least a face-to-face contact with the adult or the adult's legal representative or a
contact by interactive video that meets the requirements of subdivision 20b; or

(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact or a contact by interactive video that meets the requirements
of subdivision 20b with the adult or the adult's legal representative within the preceding
two months.

(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.

(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.

(f) Payment for mental health case management provided by vendors who contract with
a county deleted text begin or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribedeleted text end new text begin must be calculated in accordance with section 256B.076, subdivision 2. Payment for
mental health case management provided by vendors who contract with a tribe must be
based on a monthly rate negotiated by the tribenew text end . The deleted text begin negotiateddeleted text end rate must not exceed the
rate charged by the vendor for the same service to other payers. If the service is provided
by a team of contracted vendors, the deleted text begin county or tribe may negotiate a team rate with a vendor
who is a member of the team. Thedeleted text end team shall determine how to distribute the rate among
its members. No reimbursement received by contracted vendors shall be returned to the
county or tribe, except to reimburse the county or tribe for advance funding provided by
the county or tribe to the vendor.

(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.

(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.

(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.

(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.

(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:

(1) the costs of developing and implementing this section; and

(2) programming the information systems.

(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.

(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.

(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:

(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or

(2) the limits and conditions which apply to federal Medicaid funding for this service.

(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.

(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.

Sec. 9.

Minnesota Statutes 2020, section 256B.0759, subdivision 2, is amended to read:


Subd. 2.

Provider participation.

new text begin (a) Outpatient new text end substance use disorder treatment
providers may elect to participate in the demonstration project and meet the requirements
of subdivision 3. To participate, a provider must notify the commissioner of the provider's
intent to participate in a format required by the commissioner and enroll as a demonstration
project provider.

new text begin (b) Programs licensed by the Department of Human Services as a residential treatment
program according to section 245G.21 and that receive payment under this chapter must
enroll as a demonstration project provider and meet the requirements of subdivision 3 by
January 1, 2022. Programs that do not meet the requirements under this paragraph are
ineligible for payment for services provided under section 256B.0625.
 new text end

new text begin (c) Programs licensed by the Department of Human Services as a withdrawal management
program according to chapter 245F and that receive payment under this chapter must enroll
as a demonstration project provider and meet the requirements of subdivision 3 by January
1, 2022. Programs that do not meet the requirements under this paragraph are ineligible for
payment for services provided under section 256B.0625.
 new text end

new text begin (d) Out-of-state residential substance use disorder treatment programs that receive
payment under this chapter must enroll as a demonstration project provider and meet the
requirements of subdivision 3 by January 1, 2022. Programs that do not meet the requirements
under this paragraph are ineligible for payment for services provided under section
256B.0625.
 new text end

new text begin (e) Tribally licensed programs may elect to participate in the demonstration project and
meet the requirements of subdivision 3. The Department of Human Services must consult
with tribal nations to discuss participation in the substance use disorder demonstration
project.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021.
 new text end

Sec. 10.

Minnesota Statutes 2020, section 256B.0759, subdivision 4, is amended to read:


Subd. 4.

Provider payment rates.

(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirementsnew text begin , provider standards
under subdivision 3,new text end and provide evidence of formal referral arrangements with providers
delivering step-up or step-down levels of care.

new text begin (b) The commissioner may temporarily suspend payments to the provider according to
section 256B.04, subdivision 21, paragraph (d), if the requirements in paragraph (a) are not
met. Payments withheld from the provider must be made once the commissioner determines
that the requirements in paragraph (a) are met.
 new text end

deleted text begin (b)deleted text end new text begin (c)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clause (8), provided on or after July 1, 2020, payment rates must be increased
by 15 percent over the rates in effect on December 31, 2019.

deleted text begin (c)deleted text end new text begin (d)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clauses (1), (6), and (7), and adolescent treatment programs that are licensed
as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on
or after January 1, 2021, payment rates must be increased by ten percent over the rates in
effect on December 31, 2020.

deleted text begin (d)deleted text end new text begin (e)new text end Effective January 1, 2021, and contingent on annual federal approval, managed
care plans and county-based purchasing plans must reimburse providers of the substance
use disorder services meeting the criteria described in paragraph (a) who are employed by
or under contract with the plan an amount that is at least equal to the fee-for-service base
rate payment for the substance use disorder services described in paragraphs deleted text begin (b)deleted text end new text begin (c)new text end and deleted text begin (c)deleted text end new text begin
(d)new text end . The commissioner must monitor the effect of this requirement on the rate of access to
substance use disorder services and residential substance use disorder rates. Capitation rates
paid to managed care organizations and county-based purchasing plans must reflect the
impact of this requirement. This paragraph expires if federal approval is not received at any
time as required under this paragraph.

deleted text begin (e)deleted text end new text begin (f)new text end Effective July 1, 2021, contracts between managed care plans and county-based
purchasing plans and providers to whom paragraph deleted text begin (d)deleted text end new text begin (e)new text end applies must allow recovery of
payments from those providers if, for any contract year, federal approval for the provisions
of paragraph deleted text begin (d)deleted text end new text begin (e)new text end is not received, and capitation rates are adjusted as a result. Payment
recoveries must not exceed the amount equal to any decrease in rates that results from this
provision.

Sec. 11.

new text begin [256B.076] CASE MANAGEMENT SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) It is the policy of this state to ensure that individuals on
medical assistance receive cost-effective and coordinated care, including efforts to address
the profound effects of housing instability, food insecurity, and other social determinants
of health. Therefore, subject to federal approval, medical assistance covers targeted case
management services as described in this section.
 new text end

new text begin (b) The commissioner, in collaboration with tribes, counties, providers, and individuals
served, must propose further modifications to targeted case management services to ensure
a program that complies with all federal requirements, delivers services in a cost-effective
and efficient manner, creates uniform expectations for targeted case management services,
addresses health disparities, and promotes person- and family-centered services.
 new text end

new text begin Subd. 2. new text end

new text begin Rate setting. new text end

new text begin (a) The commissioner must develop and implement a statewide
rate methodology for any county that subcontracts targeted case management services to a
vendor. On January 1, 2022, or upon federal approval, whichever is later, a county must
use this methodology for any targeted case management services paid by medical assistance
and delivered through a subcontractor.
 new text end

new text begin (b) In setting this rate, the commissioner must include the following:
 new text end

new text begin (1) prevailing wages;
 new text end

new text begin (2) employee-related expense factor;
 new text end

new text begin (3) paid time off and training factors;
 new text end

new text begin (4) supervision and span of control;
 new text end

new text begin (5) distribution of time factor;
 new text end

new text begin (6) administrative factor;
 new text end

new text begin (7) absence factor;
 new text end

new text begin (8) program support factor; and
 new text end

new text begin (9) caseload sizes as described in subdivision 3.
 new text end

new text begin (c) A county may request that the commissioner authorize a rate based on a lower caseload
size when a subcontractor is assigned to serve individuals with needs, such as homelessness
or specific linguistic or cultural needs, that significantly exceed other eligible populations.
A county must include the following in the request:
 new text end

new text begin (1) the number of clients to be served by a full-time equivalent staffer;
 new text end

new text begin (2) the specific factors that require a case manager to provide significantly more hours
of reimbursable services to a client; and
 new text end

new text begin (3) how the county intends to monitor case size and outcomes.
 new text end

new text begin (d) The commissioner must adjust only the factor for caseload in paragraph (b), clause
(9), in response to a request under paragraph (c).
 new text end

new text begin Subd. 3. new text end

new text begin Caseload sizes. new text end

new text begin A county-subcontracted provider of targeted case management
services to the following populations must not exceed the following limits:
 new text end

new text begin (1) for children with severe emotional disturbance, 15 clients to one full-time equivalent
case manager;
 new text end

new text begin (2) for adults with severe and persistent mental illness, 30 clients to one full-time
equivalent case manager;
 new text end

new text begin (3) for child welfare targeted case management, 45 clients to one full-time equivalent
case manager; and
 new text end

new text begin (4) for vulnerable adults and adults who have developmental disabilities, 45 clients to
one full-time equivalent case manager.
 new text end

Sec. 12.

Minnesota Statutes 2020, section 256B.092, subdivision 4, is amended to read:


Subd. 4.

Home and community-based services for developmental disabilities.

(a)
The commissioner shall make payments to approved vendors participating in the medical
assistance program to pay costs of providing home and community-based services, including
case management service activities provided as an approved home and community-based
service, to medical assistance eligible persons with developmental disabilities who have
been screened under subdivision 7 and according to federal requirements. Federal
requirements include those services and limitations included in the federally approved
application for home and community-based services for persons with developmental
disabilities and subsequent amendments.

deleted text begin (b) Effective July 1, 1995, contingent upon federal approval and state appropriations
made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
section 40, the commissioner of human services shall allocate resources to county agencies
for home and community-based waivered services for persons with developmental disabilities
authorized but not receiving those services as of June 30, 1995, based upon the average
resource need of persons with similar functional characteristics. To ensure service continuity
for service recipients receiving home and community-based waivered services for persons
with developmental disabilities prior to July 1, 1995, the commissioner shall make available
to the county of financial responsibility home and community-based waivered services
resources based upon fiscal year 1995 authorized levels.
 deleted text end

deleted text begin (c) Home and community-based resources for all recipients shall be managed by the
county of financial responsibility within an allowable reimbursement average established
for each county. Payments for home and community-based services provided to individual
recipients shall not exceed amounts authorized by the county of financial responsibility.
For specifically identified former residents of nursing facilities, the commissioner shall be
responsible for authorizing payments and payment limits under the appropriate home and
community-based service program. Payment is available under this subdivision only for
persons who, if not provided these services, would require the level of care provided in an
intermediate care facility for persons with developmental disabilities.
 deleted text end

deleted text begin (d)deleted text end new text begin (b)new text end The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers for the elderly authorized
under this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 13.

Minnesota Statutes 2020, section 256B.092, subdivision 5, is amended to read:


Subd. 5.

Federal waivers.

(a) The commissioner shall apply for any federal waivers
necessary to secure, to the extent allowed by law, federal financial participation under United
States Code, title 42, sections 1396 et seq., as amended, for the provision of services to
persons who, in the absence of the services, would need the level of care provided in a
regional treatment center or a community intermediate care facility for persons with
developmental disabilities. The commissioner may seek amendments to the waivers or apply
for additional waivers under United States Code, title 42, sections 1396 et seq., as amended,
to contain costs. The commissioner shall ensure that payment for the cost of providing home
and community-based alternative services under the federal waiver plan shall not exceed
the cost of intermediate care services including day training and habilitation services that
would have been provided without the waivered services.

The commissioner shall seek an amendment to the 1915c home and community-based
waiver to allow properly licensed adult foster care homes to provide residential services to
up to five individuals with developmental disabilities. If the amendment to the waiver is
approved, adult foster care providers that can accommodate five individuals shall increase
their capacity to five beds, provided the providers continue to meet all applicable licensing
requirements.

(b) The commissioner, in administering home and community-based waivers for persons
with developmental disabilities, shall ensure that day services for eligible persons are not
provided by the person's residential service provider, unless the person or the person's legal
representative is offered a choice of providers and agrees in writing to provision of day
services by the residential service provider. The coordinated service and support plan for
individuals who choose to have their residential service provider provide their day services
must describe how health, safety, protection, and habilitation needs will be met, including
how frequent and regular contact with persons other than the residential service provider
will occur. The coordinated service and support plan must address the provision of services
during the day outside the residence on weekdays.

(c) When a lead agency is evaluating denials, reductions, or terminations of home and
community-based services under section 256B.0916 for an individual, the lead agency shall
offer to meet with the individual or the individual's guardian in order to discuss the
prioritization of service needs within the coordinated service and support plan. The reduction
in the authorized services for an individual due to changes in funding for waivered services
may not exceed the amount needed to ensure medically necessary services to meet the
individual's health, safety, and welfare.

new text begin (d) The commissioner shall seek approval to allow for the reconfiguration of the 1915(c)
home and community-based waivers in this section, as authorized under section 1915(c) of
the federal Social Security Act, to implement a two-waiver program structure.
 new text end

new text begin (e) The commissioner shall seek approval for the 1915(c) home and community-based
waivers in this section, as authorized under section 1915(c) of the federal Social Security
Act, to implement an individual resource allocation methodology.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 14.

Minnesota Statutes 2020, section 256B.092, subdivision 12, is amended to read:


Subd. 12.

Waivered services statewide priorities.

(a) The commissioner shall establish
statewide priorities for individuals on the waiting list for developmental disabilities (DD)
waiver services, as of January 1, 2010. The statewide priorities must include, but are not
limited to, individuals who continue to have a need for waiver services after they have
maximized the use of state plan services and other funding resources, including natural
supports, prior to accessing waiver services, and who meet at least one of the following
criteria:

(1) no longer require the intensity of services provided where they are currently living;
or

(2) make a request to move from an institutional setting.

(b) After the priorities in paragraph (a) are met, priority must also be given to individuals
who meet at least one of the following criteria:

(1) have unstable living situations due to the age, incapacity, or sudden loss of the primary
caregivers;

(2) are moving from an institution due to bed closures;

(3) experience a sudden closure of their current living arrangement;

(4) require protection from confirmed abuse, neglect, or exploitation;

(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or

(6) meet other priorities established by the department.

(c) When allocating new text begin new enrollment new text end resources to lead agencies, the commissioner must
take into consideration the number of individuals waiting who meet statewide priorities deleted text begin and
the lead agencies' current use of waiver funds and existing service optionsdeleted text end . deleted text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary base
level reserve amount for each county, group of counties, and tribe.
deleted text end

Sec. 15.

Minnesota Statutes 2020, section 256B.0924, subdivision 6, is amended to read:


Subd. 6.

Payment for targeted case management.

(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis.
In order to receive payment for an eligible adult, the provider must document at least one
contact per month and not more than two consecutive months without a face-to-face contact
with the adult or the adult's legal representative, family, primary caregiver, or other relevant
persons identified as necessary to the development or implementation of the goals of the
personal service plan.

(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), calculated as one combined average rate together with adult mental health
case management under section 256B.0625, subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section shall be the same as
the rate for adult mental health case management in effect as of December 31, 2001. Billing
and payment must identify the recipient's primary population group to allow tracking of
revenues.

(c) Payment for targeted case management provided by county-contracted vendors shall
be based on a monthly rate deleted text begin negotiated by the host countydeleted text end new text begin calculated in accordance with
section 256B.076, subdivision 2new text end . The deleted text begin negotiateddeleted text end rate must not exceed the rate charged by
the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the deleted text begin county may negotiate a team rate with a vendor who is a member
of the team. Thedeleted text end team shall determine how to distribute the rate among its members. No
reimbursement received by contracted vendors shall be returned to the county, except to
reimburse the county for advance funding provided by the county to the vendor.

(d) If the service is provided by a team that includes contracted vendors and county staff,
the costs for county staff participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor and the county may each
receive separate payment for services provided by each entity in the same month. In order
to prevent duplication of services, the county must document, in the recipient's file, the need
for team targeted case management and a description of the different roles of the team
members.

(e) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as
defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds.

(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is responsible for any federal
disallowances. The county may share this responsibility with its contracted vendors.

(g) The commissioner shall set aside five percent of the federal funds received under
this section for use in reimbursing the state for costs of developing and implementing this
section.

(h) Payments to counties for targeted case management expenditures under this section
shall only be made from federal earnings from services provided under this section. Payments
to contracted vendors shall include both the federal earnings and the county share.

(i) Notwithstanding section 256B.041, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of management
and budget. For the purposes of targeted case management services provided by county
staff under this section, the centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services provided under this section.

(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the lesser of:

(1) the last 180 days of the recipient's residency in that facility; or

(2) the limits and conditions which apply to federal Medicaid funding for this service.

(k) Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.

(l) Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.

Sec. 16.

Minnesota Statutes 2020, section 256B.094, subdivision 6, is amended to read:


Subd. 6.

Medical assistance reimbursement of case management services.

(a) Medical
assistance reimbursement for services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between the case manager and the
client, client's family, primary caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of the goals of the individual
service plan regarding the status of the client, the individual service plan, or the goals for
the client. These contacts must meet the minimum standards in clauses (1) and (2):

(1) there must be a face-to-face contact at least once a month except as provided in clause
(2); and

(2) for a client placed outside of the county of financial responsibility, or a client served
by tribal social services placed outside the reservation, in an excluded time facility under
section 256G.02, subdivision 6, or through the Interstate Compact for the Placement of
Children, section 260.93, and the placement in either case is more than 60 miles beyond
the county or reservation boundaries, there must be at least one contact per month and not
more than two consecutive months without a face-to-face contact.

(b) Except as provided under paragraph (c), the payment rate is established using time
study data on activities of provider service staff and reports required under sections 245.482
and 256.01, subdivision 2, paragraph (p).

(c) Payments for tribes may be made according to section 256B.0625 or other relevant
federally approved rate setting methodology for child welfare targeted case management
provided by Indian health services and facilities operated by a tribe or tribal organization.

(d) Payment for case management provided by county deleted text begin or tribal social servicesdeleted text end contracted
vendors deleted text begin shall be based on a monthly rate negotiated by the host county or tribal social
servicesdeleted text end new text begin must be calculated in accordance with section 256B.076, subdivision 2. Payment
for case management provided by vendors who contract with a tribe must be based on a
monthly rate negotiated by the tribenew text end . The deleted text begin negotiateddeleted text end rate must not exceed the rate charged
by the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the deleted text begin county or tribal social services may negotiate a team rate with a
vendor who is a member of the team. Thedeleted text end team shall determine how to distribute the rate
among its members. No reimbursement received by contracted vendors shall be returned
to the county or tribal social services, except to reimburse the county or tribal social services
for advance funding provided by the county or tribal social services to the vendor.

(e) If the service is provided by a team that includes contracted vendors and county or
tribal social services staff, the costs for county or tribal social services staff participation in
the team shall be included in the rate for county or tribal social services provided services.
In this case, the contracted vendor and the county or tribal social services may each receive
separate payment for services provided by each entity in the same month. To prevent
duplication of services, each entity must document, in the recipient's file, the need for team
case management and a description of the roles and services of the team members.

Separate payment rates may be established for different groups of providers to maximize
reimbursement as determined by the commissioner. The payment rate will be reviewed
annually and revised periodically to be consistent with the most recent time study and other
data. Payment for services will be made upon submission of a valid claim and verification
of proper documentation described in subdivision 7. Federal administrative revenue earned
through the time study, or under paragraph (c), shall be distributed according to earnings,
to counties, reservations, or groups of counties or reservations which have the same payment
rate under this subdivision, and to the group of counties or reservations which are not
certified providers under section 256F.10. The commissioner shall modify the requirements
set out in Minnesota Rules, parts 9550.0300 to 9550.0370, as necessary to accomplish this.

Sec. 17.

Minnesota Statutes 2020, section 256B.0949, is amended by adding a subdivision
to read:


new text begin Subd. 16a. new text end

new text begin Background studies. new text end

new text begin The requirements for background studies under this
section shall be met by an early intensive developmental and behavioral intervention services
agency through the commissioner's NETStudy system as provided under sections 245C.03,
subdivision 15, and 245C.10, subdivision 17.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 18.

Minnesota Statutes 2020, section 256B.49, subdivision 11, is amended to read:


Subd. 11.

Authority.

(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the new text begin federal new text end Social
Security Act to serve persons under the age of 65 who are determined to require the level
of care provided in a nursing home and persons who require the level of care provided in a
hospital. The commissioner shall apply for the home and community-based waivers in order
to:

(1) promote the support of persons with disabilities in the most integrated settings;

(2) expand the availability of services for persons who are eligible for medical assistance;

(3) promote cost-effective options to institutional care; and

(4) obtain federal financial participation.

(b) The provision of waivered services to medical assistance recipients with disabilities
shall comply with the requirements outlined in the federally approved applications for home
and community-based services and subsequent amendments, including provision of services
according to a service plan designed to meet the needs of the individual. For purposes of
this section, the approved home and community-based application is considered the necessary
federal requirement.

(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.

(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
new text begin federal new text end Social Security Act, to allow medical assistance eligibility under this section for
children under age 21 without deeming of parental income or assets.

(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.

(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.

new text begin (g) The commissioner shall seek approval to reconfigure the 1915(c) home and
community-based waivers in this section to implement a two-waiver program structure.
 new text end

new text begin (h) The commissioner shall seek approval for the 1915(c) home and community-based
waivers in this section, as authorized under section 1915(c) of the federal Social Security
Act, to implement an individual resource allocation methodology.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 19.

Minnesota Statutes 2020, section 256B.49, subdivision 11a, is amended to read:


Subd. 11a.

Waivered services statewide priorities.

(a) The commissioner shall establish
statewide priorities for individuals on the waiting list for community alternative care,
community access for disability inclusion, and brain injury waiver services, as of January
1, 2010. The statewide priorities must include, but are not limited to, individuals who
continue to have a need for waiver services after they have maximized the use of state plan
services and other funding resources, including natural supports, prior to accessing waiver
services, and who meet at least one of the following criteria:

(1) no longer require the intensity of services provided where they are currently living;
or

(2) make a request to move from an institutional setting.

(b) After the priorities in paragraph (a) are met, priority must also be given to individuals
who meet at least one of the following criteria:

(1) have unstable living situations due to the age, incapacity, or sudden loss of the primary
caregivers;

(2) are moving from an institution due to bed closures;

(3) experience a sudden closure of their current living arrangement;

(4) require protection from confirmed abuse, neglect, or exploitation;

(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or

(6) meet other priorities established by the department.

(c) When allocating new text begin new enrollment new text end resources to lead agencies, the commissioner must
take into consideration the number of individuals waiting who meet statewide priorities deleted text begin and
the lead agencies' current use of waiver funds and existing service optionsdeleted text end . deleted text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary base
level reserve amount for each county, group of counties, and tribe.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 20.

Minnesota Statutes 2020, section 256B.49, subdivision 17, is amended to read:


Subd. 17.

Cost of services and supports.

(a) The commissioner shall ensure that the
average per capita expenditures estimated in any fiscal year for home and community-based
waiver recipients does not exceed the average per capita expenditures that would have been
made to provide institutional services for recipients in the absence of the waiver.

deleted text begin (b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based waivered
service resources available to support recipients with disabilities in need of the level of care
provided in a nursing facility or a hospital. The commissioner shall allocate resources to
single counties and county partnerships in a manner that reflects consideration of:
 deleted text end

deleted text begin (1) an incentive-based payment process for achieving outcomes;
 deleted text end

deleted text begin (2) the need for a state-level risk pool;
 deleted text end

deleted text begin (3) the need for retention of management responsibility at the state agency level; and
 deleted text end

deleted text begin (4) a phase-in strategy as appropriate.
 deleted text end

deleted text begin (c) Until the allocation methods described in paragraph (b) are implemented, the annual
allowable reimbursement level of home and community-based waiver services shall be the
greater of:
 deleted text end

deleted text begin (1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of any
provider rate increase appropriated for home and community-based services; or
 deleted text end

deleted text begin (2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The increased
reimbursement level must be necessary to allow the recipient to be discharged from an
institution or to prevent imminent placement in an institution. The additional reimbursement
may be used to secure environmental modifications; assistive technology and equipment;
and increased costs for supervision, training, and support services necessary to address the
recipient's extraordinary needs. The commissioner may approve an increased reimbursement
level for up to one year of the recipient's relocation from an institution or up to six months
of a determination that a current waiver recipient is at imminent risk of being placed in an
institution.
 deleted text end

deleted text begin (d)deleted text end new text begin (b)new text end Beginning July 1, 2001, medically necessary home care nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
to 256B.0654 and 256B.0659. The rate established by the commissioner for registered nurse
or licensed practical nurse services under any home and community-based waiver as of
January 1, 2001, shall not be reduced.

deleted text begin (e)deleted text end new text begin (c)new text end Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care services,
the county must negotiate a revised per diem rate for room and board and waiver services
that reflects the legislated rate reduction and results in an overall average per diem reduction
for all foster care recipients in that home. The revised per diem must allow the provider to
maintain, as much as possible, the level of services or enhanced services provided in the
residence, while mitigating the losses of the legislated rate reduction.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 21.

Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision
to read:


new text begin Subd. 28. new text end

new text begin Customized living moratorium for brain injury and community access
for disability inclusion waivers. new text end

new text begin (a) Notwithstanding section 245A.03, subdivision 2,
paragraph (a), clause (23), the commissioner shall not enroll new customized living settings
serving four or fewer people in a single-family home to deliver customized living services
as defined under the brain injury or community access for disability inclusion waiver plans
under section 256B.49 to prevent new developments of customized living settings that
otherwise meet the residential program definition under section 245A.02, subdivision 14.
 new text end

new text begin (b) The commissioner may approve an exception to paragraph (a) when:
 new text end

new text begin (1) a customized living setting with a change in ownership at the same address is in
existence and operational on or before June 30, 2021; and
 new text end

new text begin (2) a customized living setting is serving four or fewer people in a multiple-family
dwelling if each person has their own self-contained living unit that contains living, sleeping,
eating, cooking, and bathroom areas.
 new text end

new text begin (c) Customized living settings operational on or before June 30, 2021, are considered
existing customized living settings.
 new text end

new text begin (d) For any new customized living settings operational on or after July 1, 2021, serving
four or fewer people in a single-family home to deliver customized living services as defined
in paragraph (a), the authorizing lead agency is financially responsible for all home and
community-based service payments in the setting.
 new text end

new text begin (e) For purposes of this subdivision, "operational" means customized living services are
authorized and delivered to a person on or before June 30, 2021, in the customized living
setting.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021. This section applies only
to customized living services as defined under the brain injury or community access for
disability inclusion waiver plans under section Minnesota Statutes, section 256B.49.
 new text end

Sec. 22.

Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:


Subd. 5.

Base wage index and standard component values.

(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and

(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);

(3) for day services, day support services, and prevocational services, 20 percent of the
median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093);

(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employers, except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employers;

(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);

(6) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);

(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);

(8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

(9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);

(10) for in-home family support and individualized home supports with family training
staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30 percent of
the median wage for community social service specialist (SOC code 21-1099); 40 percent
of the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);

(11) for individualized home supports with training services staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);

(12) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);

(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(14) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);

(16) for individualized home support staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);

(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);

(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);

(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and

(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).

(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) general administrative support ratio: 13.25 percent;

(6) program-related expense ratio: 1.3 percent; and

(7) absence and utilization factor ratio: 3.9 percent.

(c) Component values for family foster care are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) general administrative support ratio: 3.3 percent;

(6) program-related expense ratio: 1.3 percent; and

(7) absence factor: 1.7 percent.

(d) Component values for day training and habilitation, day support services, and
prevocational services are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan support ratio: 5.6 percent;

(6) client programming and support ratio: ten percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 1.8 percent; and

(9) absence and utilization factor ratio: 9.4 percent.

new text begin (e) Component values for day support services and prevocational services delivered
remotely are:
 new text end

new text begin (1) competitive workforce factor: 4.7 percent;
 new text end

new text begin (2) supervisory span of control ratio: 11 percent;
 new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (5) program plan support ratio: 5.6 percent;
 new text end

new text begin (6) client programming and support ratio: 7.67 percent;
 new text end

new text begin (7) general administrative support ratio: 13.25 percent;
 new text end

new text begin (8) program-related expense ratio: 1.8 percent; and
 new text end

new text begin (9) absence and utilization factor ratio: 9.4 percent.
 new text end

deleted text begin (e)deleted text end new text begin (f)new text end Component values for adult day services are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan support ratio: 5.6 percent;

(6) client programming and support ratio: 7.4 percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 1.8 percent; and

(9) absence and utilization factor ratio: 9.4 percent.

deleted text begin (f)deleted text end new text begin (g)new text end Component values for unit-based services with programming are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan supports ratio: 15.5 percent;

(6) client programming and supports ratio: 4.7 percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 6.1 percent; and

(9) absence and utilization factor ratio: 3.9 percent.

new text begin (h) Component values for unit-based services with programming delivered remotely
are:
 new text end

new text begin (1) competitive workforce factor: 4.7 percent;
 new text end

new text begin (2) supervisory span of control ratio: 11 percent;
 new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (5) program plan supports ratio: 5.6 percent;
 new text end

new text begin (6) client programming and supports ratio: 1.53 percent;
 new text end

new text begin (7) general administrative support ratio: 13.25 percent;
 new text end

new text begin (8) program-related expense ratio: 6.1 percent; and
 new text end

new text begin (9) absence and utilization factor ratio: 3.9 percent.
 new text end

deleted text begin (g)deleted text end new text begin (i)new text end Component values for unit-based services without programming except respite
are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan support ratio: 7.0 percent;

(6) client programming and support ratio: 2.3 percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 2.9 percent; and

(9) absence and utilization factor ratio: 3.9 percent.

new text begin (j) Component values for unit-based services without programming delivered remotely,
except respite, are:
 new text end

new text begin (1) competitive workforce factor: 4.7 percent;
 new text end

new text begin (2) supervisory span of control ratio: 11 percent;
 new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (5) program plan support ratio: 1.3 percent;
 new text end

new text begin (6) client programming and support ratio: 1.14 percent;
 new text end

new text begin (7) general administrative support ratio: 13.25 percent;
 new text end

new text begin (8) program-related expense ratio: 2.9 percent; and
 new text end

new text begin (9) absence and utilization factor ratio: 3.9 percent.
 new text end

deleted text begin (h)deleted text end new text begin (k)new text end Component values for unit-based services without programming for respite are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) general administrative support ratio: 13.25 percent;

(6) program-related expense ratio: 2.9 percent; and

(7) absence and utilization factor ratio: 3.9 percent.

deleted text begin (i)deleted text end new text begin (l)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.

deleted text begin (j)deleted text end new text begin (m)new text end Beginning February 1, 2021, and every two years thereafter, the commissioner
shall report to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over health and human services policy and finance an analysis
of the competitive workforce factor. The report must include recommendations to update
the competitive workforce factor using:

(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;

(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and

(3) workforce data as required under subdivision 10a, paragraph (g).

The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.

deleted text begin (k)deleted text end new text begin (n)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph
(f), clause (6); deleted text begin anddeleted text end paragraph (g), clause (6); new text begin paragraph (h), clause (6); paragraph (i), clause
6; and paragraph (j), clause (6); new text end subdivision 6, paragraphs (b), clauses (9) and (10), and (e),
clause (10); and subdivision 7, clauses (11), (17), and (18), for changes in the Consumer
Price Index. The commissioner shall adjust these values higher or lower by the percentage
change in the CPI-U from the date of the previous update to the data available 30 months
and one day prior to the scheduled update. The commissioner shall publish these updated
values and load them into the rate management system.

deleted text begin (l)deleted text end new text begin (o)new text end Upon the implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin (l)new text end and deleted text begin (k)deleted text end new text begin (n)new text end , rate
adjustments authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108,
article 7, section 60; and Laws 2014, chapter 312, article 27, section 75, shall be removed
from service rates calculated under this section.

deleted text begin (m)deleted text end new text begin (p)new text end Any rate adjustments applied to the service rates calculated under this section
outside of the cost components and rate methodology specified in this section shall be
removed from rate calculations upon implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin
(l)new text end and deleted text begin (k)deleted text end new text begin (n)new text end .

deleted text begin (n)deleted text end new text begin (q)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 23.

Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to read:


Subd. 6.

Payments for residential support services.

(a) For purposes of this subdivision,
residential support services includes 24-hour customized living services, community
residential services, customized living services, family residential services, foster care
services, integrated community supports, and supportive living services daily.

(b) Payments for community residential services, corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care services
must be calculated as follows:

(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages;

(6) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(7) combine the results of clauses (5) and (6), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (3). This is defined as the direct staffing cost;

(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4);

(9) for client programming and supports, the commissioner shall add $2,179; and

(10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

(c) The total rate must be calculated using the following steps:

(1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (8);

(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(d) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.new text begin The commissioner shall establish acuity-based input limits, based on case
mix, for customized living and 24-hour customized living rates determined under this section.
new text end

(e) Payments for integrated community support services must be calculated as follows:

(1) the base shared staffing shall be eight hours divided by the number of people receiving
support in the integrated community support setting;

(2) the individual staffing hours shall be the average number of direct support hours
provided directly to the service recipient;

(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;

(4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (3) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);

(5) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (4);

(6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;

(7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause
(21);

(8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;

(9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and

(10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.

(f) The total rate must be calculated as follows:

(1) add the results of paragraph (e), clauses (9) and (10);

(2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(g) The payment methodology for customized living and 24-hour customized living
services must be the customized living tool. The commissioner shall revise the customized
living tool to reflect the services and activities unique to disability-related recipient needs
and adjust for regional differences in the cost of providing services.

(h) The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
 new text end

Sec. 24.

Minnesota Statutes 2020, section 256B.4914, subdivision 7, is amended to read:


Subd. 7.

Payments for day programs.

Payments for services with day programs
including adult day services, day treatment and habilitation, day support services,
prevocational services, and structured day servicesnew text begin , provided in person or remotely,new text end must
be calculated as follows:

(1) determine the number of units of service and staffing ratio to meet a recipient's needs:

(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and

(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (d), clause (1);

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage;

(6) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (2)new text begin , for in-person services or
subdivision 5, paragraph (e), clause (2), for remote servicesnew text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(3)new text begin , for in-person services or subdivision 5, paragraph (e), clause (3), for remote servicesnew text end .
This is defined as the direct staffing rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (5)new text begin , for in-person services or
subdivision 5, paragraph (e), clause (5), for remote servicesnew text end ;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (4)new text begin , for in-person services
or subdivision 5, paragraph (e), clause (4), for remote servicesnew text end ;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (6)new text begin , for
in-person services or subdivision 5, paragraph (e), clause (6), for remote servicesnew text end ;

(11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needsnew text begin for in-person service onlynew text end ;

(12) for adult day bath services, add $7.01 per 15 minute unit;

(13) this is the subtotal rate;

(14) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(15) divide the result of clause (13) by one minus the result of clause (14). This is the
total payment amount;

(16) adjust the result of clause (15) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;

(17) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:

(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;

(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;

(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or

(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;

(18) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:

(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;

(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;

(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or

(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 25.

Minnesota Statutes 2020, section 256B.4914, subdivision 8, is amended to read:


Subd. 8.

Payments for unit-based services with programming.

Payments for unit-based
services with programming, including employment exploration services, employment
development services, housing access coordination, individualized home supports with
family training, individualized home supports with training, in-home family support,
independent living skills training, and hourly supported living services provided to an
individual outside of any day or residential service plannew text begin , provided in person or remotely,new text end
must be calculated as follows, unless the services are authorized separately under subdivision
6 or 7:

(1) determine the number of units of service to meet a recipient's needs;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (1);

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of direct staff hours by the appropriate staff wage;

(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (2),new text begin for in-person services or
subdivision 5, paragraph (h), clause (2), for remote services,new text end and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (h), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan supports ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (h), clause (5), for remote servicesnew text end ;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (h), clause (4), for remote servicesnew text end ;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and supports ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (6)new text begin ,
for in-person services or subdivision 5, paragraph (h), clause (6), for remote servicesnew text end ;

(11) this is the subtotal rate;

(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;

(14) for employment exploration services provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed five. For
employment support services provided in a shared manner, divide the total payment amount
in clause (13) by the number of service recipients, not to exceed six. For independent living
skills training, individualized home supports with training, and individualized home supports
with family training provided in a shared manner, divide the total payment amount in clause
(13) by the number of service recipients, not to exceed two; and

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 26.

Minnesota Statutes 2020, section 256B.4914, subdivision 9, is amended to read:


Subd. 9.

Payments for unit-based services without programming.

Payments for
unit-based services without programming, including individualized home supports, night
supervision, personal support, respite, and companion care provided to an individual outside
of any day or residential service plannew text begin , provided in person or remotely,new text end must be calculated
as follows unless the services are authorized separately under subdivision 6 or 7:

(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (1);

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of direct staff hours by the appropriate staff wage;

(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (2)new text begin , for in-person services or
subdivision 5, paragraph (j), clause (2), for remote servicesnew text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (j), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (j), clause (5), for remote servicesnew text end ;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (j), clause (4), for remote servicesnew text end ;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (6)new text begin , for
in-person services or subdivision 5, paragraph (j), clause (6), for remote servicesnew text end ;

(11) this is the subtotal rate;

(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;

(14) for respite services, determine the number of day units of service to meet an
individual's needs;

(15) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(16) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (1);

(17) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (16);

(18) multiply the number of direct staff hours by the appropriate staff wage;

(19) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(20) combine the results of clauses (18) and (19), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin
(k)new text end , clause (3). This is defined as the direct staffing rate;

(21) for employee-related expenses, multiply the result of clause (20) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (4);

(22) this is the subtotal rate;

(23) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(24) divide the result of clause (22) by one minus the result of clause (23). This is the
total payment amount;

(25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;

(26) for respite care services provided in a shared manner, divide the total payment
amount in clause (24) by the number of service recipients, not to exceed three; and

(27) adjust the result of clauses (13), (25), and (26) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 27.

Minnesota Statutes 2020, section 256I.05, subdivision 1a, is amended to read:


Subd. 1a.

Supplementary service rates.

(a) Subject to the provisions of section 256I.04,
subdivision 3, the county agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board if the residence is licensed by or registered
by the Department of Health, or licensed by the Department of Human Services to provide
services in addition to room and board, and if the provider of services is not also concurrently
receiving funding for services for a recipient under a home and community-based waiver
under title XIX of the new text begin federal new text end Social Security Act; or funding from the medical assistance
program under section 256B.0659, for personal care services for residents in the setting; or
residing in a setting which receives funding under section 245.73. If funding is available
for other necessary services through a home and community-based waiver, or personal care
services under section 256B.0659, then the housing support rate is limited to the rate set in
subdivision 1. Unless otherwise provided in law, in no case may the supplementary service
rate exceed $426.37. The registration and licensure requirement does not apply to
establishments which are exempt from state licensure because they are located on Indian
reservations and for which the tribe has prescribed health and safety requirements. Service
payments under this section may be prohibited under rules to prevent the supplanting of
federal funds with state funds. The commissioner shall pursue the feasibility of obtaining
the approval of the Secretary of Health and Human Services to provide home and
community-based waiver services under title XIX of the new text begin federal new text end Social Security Act for
residents who are not eligible for an existing home and community-based waiver due to a
primary diagnosis of mental illness or chemical dependency and shall apply for a waiver if
it is determined to be cost-effective.

(b) The commissioner is authorized to make cost-neutral transfers from the housing
support fund for beds under this section to other funding programs administered by the
department after consultation with the deleted text begin county or countiesdeleted text end new text begin agencynew text end in which the affected beds
are located. The commissioner may also make cost-neutral transfers from the housing support
fund to deleted text begin county human servicedeleted text end agencies for beds permanently removed from the housing
support census under a plan submitted by the deleted text begin countydeleted text end agency and approved by the
commissioner. The commissioner shall report the amount of any transfers under this provision
annually to the legislature.

(c) deleted text begin Countiesdeleted text end new text begin Agenciesnew text end must not negotiate supplementary service rates with providers of
housing support that are licensed as board and lodging with special services and that do not
encourage a policy of sobriety on their premises and make referrals to available community
services for volunteer and employment opportunities for residents.

new text begin EFFECTIVE DATE. new text end

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

Sec. 28.

Minnesota Statutes 2020, section 256I.05, subdivision 11, is amended to read:


Subd. 11.

Transfer of emergency shelter funds.

(a) The commissioner shall make a
cost-neutral transfer of funding from the housing support fund to deleted text begin county human service
agenciesdeleted text end new text begin the agencynew text end for emergency shelter beds removed from the housing support census
under a biennial plan submitted by the deleted text begin countydeleted text end new text begin agencynew text end and approved by the commissioner.
The plan must describe: (1) anticipated and actual outcomes for persons experiencing
homelessness in emergency shelters; (2) improved efficiencies in administration; (3)
requirements for individual eligibility; and (4) plans for quality assurance monitoring and
quality assurance outcomes. The commissioner shall review the deleted text begin countydeleted text end new text begin agencynew text end plan to
monitor implementation and outcomes at least biennially, and more frequently if the
commissioner deems necessary.

(b) The funding under paragraph (a) may be used for the provision of room and board
or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
annually, and the room and board portion of the allocation shall be adjusted according to
the percentage change in the housing support room and board rate. The room and board
portion of the allocation shall be determined at the time of transfer. The commissioner or
deleted text begin countydeleted text end new text begin agencynew text end may return beds to the housing support fund with 180 days' notice, including
financial reconciliation.

new text begin EFFECTIVE DATE. new text end

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

Sec. 29. new text begin WAIVER REIMAGINE PHASE II.
new text end

new text begin (a) The commissioner of human services must implement a two-home and
community-based services waiver program structure, as authorized under section 1915(c)
of the federal Social Security Act, that serves persons who are determined by a certified
assessor to require the levels of care provided in a nursing home, a hospital, a neurobehavioral
hospital, or an intermediate care facility for persons with developmental disabilities.
 new text end

new text begin (b) The commissioner of human services must implement an individualized budget
methodology, as authorized under section 1915(c) of the federal Social Security Act, that
serves persons who are determined by a certified assessor to require the levels of care
provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care
facility for persons with developmental disabilities.
 new text end

new text begin (c) The commissioner of human services may seek all federal authority necessary to
implement this section.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 30. new text begin DIRECTION TO THE COMMISSIONER; CUSTOMIZED LIVING
REPORT.
new text end

new text begin (a) By January 15, 2022, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance. The report must include the commissioner's:
 new text end

new text begin (1) assessment of the prevalence of customized living services provided under Minnesota
Statutes, section 256B.49, supplanting the provision of residential services and supports
licensed under Minnesota Statutes, chapter 245D, and provided in settings licensed under
Minnesota Statutes, chapter 245A;
 new text end

new text begin (2) recommendations regarding the continuation of the moratorium on home and
community-based services customized living settings under Minnesota Statutes, section
256B.49, subdivision 28;
 new text end

new text begin (3) other policy recommendations to ensure that customized living services are being
provided in a manner consistent with the policy objectives of the foster care licensing
moratorium under Minnesota Statutes, section 245A.03, subdivision 7; and
 new text end

new text begin (4) recommendations for needed statutory changes to implement the transition from
existing four-person or fewer customized living settings to corporate adult foster care or
community residential settings.
 new text end

new text begin (b) The commissioner of health shall provide the commissioner of human services with
the required data to complete the report in paragraph (a) and implement the moratorium on
home and community-based services customized living settings under Minnesota Statutes,
section 256B.49, subdivision 28. The data must include, at a minimum, each registered
housing with services establishment under Minnesota Statutes, chapter 144D, enrolled as
a customized living setting to deliver customized living services as defined under the brain
injury or community access for disability inclusion waiver plans under Minnesota Statutes,
section 256B.49.
 new text end

Sec. 31. new text begin RATE INCREASE FOR DIRECT SUPPORT SERVICES WORKFORCE.
new text end

new text begin (a) Effective October 1, 2021, or upon federal approval, whichever is later, if the labor
agreement between the state of Minnesota and the Service Employees International Union
Healthcare Minnesota under Minnesota Statutes, section 179A.54, is approved pursuant to
Minnesota Statutes, section 3.855, the commissioner of human services shall increase:
 new text end

new text begin (1) reimbursement rates, individual budgets, grants, or allocations by 4.14 percent for
services under paragraph (b) provided on or after October 1, 2021, or upon federal approval,
whichever is later, to implement the minimum hourly wage, holiday, and paid time off
provisions of that agreement;
 new text end

new text begin (2) reimbursement rates, individual budgets, grants, or allocations by 2.95 percent for
services under paragraph (b) provided on or after July 1, 2022, or upon federal approval,
whichever is later, to implement the minimum hourly wage, holiday, and paid time off
provisions of that agreement;
 new text end

new text begin (3) individual budgets, grants, or allocations by 1.58 percent for services under paragraph
(c) provided on or after October 1, 2021, or upon federal approval, whichever is later, to
implement the minimum hourly wage, holiday, and paid time off provisions of that
agreement; and
 new text end

new text begin (4) individual budgets, grants, or allocations by .81 percent for services under paragraph
(c) provided on or after July 1, 2022, or upon federal approval, whichever is later, to
implement the minimum hourly wage, holiday, and paid time off provisions of that
agreement.
 new text end

new text begin (b) The rate changes described in paragraph (a), clauses (1) and (2), apply to direct
support services provided through a covered program, as defined in Minnesota Statutes,
section 256B.0711, subdivision 1, with the exception of consumer-directed community
supports available under programs established pursuant to home and community-based
service waivers authorized under section 1915(c) of the federal Social Security Act and
Minnesota Statutes, including but not limited to chapter 256S and sections 256B.092 and
256B.49, and under the alternative care program under Minnesota Statutes, section
256B.0913.
 new text end

new text begin (c) The funding changes described in paragraph (a), clauses (3) and (4), apply to
consumer-directed community supports available under programs established pursuant to
home and community-based service waivers authorized under section 1915(c) of the federal
Social Security Act, and Minnesota Statutes, including but not limited to chapter 256S and
sections 256B.092 and 256B.49, and under the alternative care program under Minnesota
Statutes, section 256B.0913.
 new text end

Sec. 32. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; RATE
RECOMMENDATIONS FOR OPIOID TREATMENT PROGRAMS.
new text end

new text begin The commissioner of human services shall evaluate the rate structure for opioid treatment
programs licensed under Minnesota Statutes, section 245G.22, and report recommendations,
including a revised rate structure and proposed draft legislation, to the chairs and ranking
minority members of the legislative committees with jurisdiction over human services policy
and finance by October 1, 2021.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021.
 new text end

Sec. 33. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2020, section 256B.0596, new text end new text begin is repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2020, sections 245A.191; and 256B.097, new text end new text begin are repealed effective
July 1, 2021.
 new text end

new text begin (c) new text end new text begin Minnesota Statutes 2020, sections 256B.0916, subdivisions 2, 3, 4, 5, 8, 11, and 12;
and 256B.49, subdivisions 26 and 27, new text end new text begin are repealed effective January 1, 2023, or upon federal
approval, whichever is later.
 new text end

ARTICLE 3

DIRECT CARE AND TREATMENT

Section 1.

Minnesota Statutes 2020, section 246.54, subdivision 1b, is amended to read:


Subd. 1b.

Community behavioral health hospitals.

A county's payment of the cost of
care provided at state-operated community-based behavioral health hospitalsnew text begin for adults and
childrennew text end 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.

ARTICLE 4

HEALTH CARE

Section 1.

Minnesota Statutes 2020, section 256.9695, subdivision 1, is amended to read:


Subdivision 1.

Appeals.

A hospital may appeal a decision arising from the application
of standards or methods under section 256.9685, 256.9686, or 256.969, if an appeal would
result in a change to the hospital's payment rate or payments. Both overpayments and
underpayments that result from the submission of appeals shall be implemented. Regardless
of any appeal outcome, relative values, Medicare wage indexes, Medicare cost-to-charge
ratios, and policy adjusters shall not be changed. The appeal shall be heard by an
administrative law judge according to sections 14.57 to 14.62, or upon agreement by both
parties, according to a modified appeals procedure established by the commissioner and the
Office of Administrative Hearings. In any proceeding under this section, the appealing party
must demonstrate by a preponderance of the evidence that the commissioner's determination
is incorrect or not according to law.

To appeal a payment rate or payment determination or a determination made from base
year information, the hospital shall file a written appeal request to the commissioner within
60 days of the date the preliminary payment rate determination was mailed. The appeal
request shall specify: (i) the disputed items; (ii) the authority in federal or state statute or
rule upon which the hospital relies for each disputed item; and (iii) the name and address
of the person to contact regarding the appeal. Facts to be considered in any appeal of base
year information are limited to those in existence deleted text begin 12deleted text end new text begin 18new text end months after the last day of the
calendar year that is the base year for the payment rates in dispute.

Sec. 2.

Minnesota Statutes 2020, section 256B.057, subdivision 3, is amended to read:


Subd. 3.

Qualified Medicare beneficiaries.

new text begin (a) new text end A person deleted text begin who is entitled to Part A
Medicare benefits, whose income is equal to or less than 100 percent of the federal poverty
guidelines, and whose assets are no more than $10,000 for a single individual and $18,000
for a married couple or family of two or more,deleted text end is eligible for medical assistance
reimbursement of new text begin Medicare new text end Part A and Part B premiums, Part A and Part B coinsurance
and deductibles, and cost-effective premiums for enrollment with a health maintenance
organization or a competitive medical plan under section 1876 of the Social Security Actdeleted text begin .deleted text end new text begin
if:
new text end

new text begin (1) the person is entitled to Medicare Part A benefits;
 new text end

new text begin (2) the person's income is equal to or less than 100 percent of the federal poverty
guidelines; and
 new text end

new text begin (3) the person's assets are no more than (i) $10,000 for a single individual, or (ii) $18,000
for a married couple or family of two or more; or, when the resource limits for eligibility
for the Medicare Part D extra help low income subsidy (LIS) exceed either amount in item
(i) or (ii), the person's assets are no more than the LIS resource limit in United States Code,
title 42, section 1396d, subsection (p).
 new text end

new text begin (b)new text end Reimbursement of the Medicare coinsurance and deductibles, when added to the
amount paid by Medicare, must not exceed the total rate the provider would have received
for the same service or services if the person were a medical assistance recipient with
Medicare coverage. Increases in benefits under Title II of the Social Security Act shall not
be counted as income for purposes of this subdivision until July 1 of each year.

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2020, 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 deleted text begin not provide specific roles and responsibilities by telemedicine unless approved
by the commissionerdeleted text end new text begin provide services by telemedicine when necessary to ensure the
continuation of psychiatric and medication services availability for clients and to maintain
statutory requirements for psychiatric care provider staffing levelsnew text end ; 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 section 245G.11, subdivision 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 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, paragraph (a), 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. 4.

Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:


Subd. 3b.

Telemedicine services.

(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. deleted text begin Coverage is
limited to three telemedicine services per enrollee per calendar week, except as provided
in paragraph (f).deleted text end Telemedicine services shall be paid at the full allowable rate.

(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:

(1) has identified the categories or types of services the health care provider will provide
via telemedicine;

(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;

(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;

(4) has established protocols addressing how and when to discontinue telemedicine
services; and

(5) has an established quality assurance process related to telemedicine services.

(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:

(1) the type of service provided by telemedicine;

(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;

(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;

(5) the location of the originating site and the distant site;

(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and

(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).

(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating sitenew text begin , including the patient's home,new text end and the licensed health care
provider is at a distant site. A communication between licensed health care providers, or a
licensed health care provider and a patient that consists solely of a telephone conversation,
e-mail, or facsimile transmission does not constitute telemedicine consultations or services.
Telemedicine may be provided by means of real-time two-way, interactive audio and visual
communications, including the application of secure video conferencing or store-and-forward
technology to provide or support health care delivery, which facilitate the assessment,
diagnosis, consultation, treatment, education, and care management of a patient's health
care.

(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6deleted text begin ,deleted text end new text begin ;new text end a community paramedic as defined
under section 144E.001, subdivision 5fdeleted text begin , ordeleted text end new text begin ;new text end a mental health practitioner defined under section
245.462, subdivision 17, or 245.4871, subdivision 26deleted text begin , working under the general supervision
of a mental health professional, anddeleted text end new text begin ;new text end a community health worker who meets the criteria
under subdivision 49, paragraph (a)new text begin ; a mental health certified peer specialist under section
256B.0615, subdivision 5; a mental health certified family peer specialist under section
256B.0616, subdivision 5; a mental health rehabilitation worker under section 256B.0623,
subdivision 5, paragraph (a), clause (4), and paragraph (b); a mental health behavioral aide
under section 256B.0943, subdivision 7, paragraph (b), clause (3); an alcohol and drug
counselor under section 245G.11, subdivision 5; a treatment coordinator under section
245G.11, subdivision 7; or a recovery peer under section 245G.11, subdivision 8new text end ; "health
care provider" is defined under section 62A.671, subdivision 3; and "originating site" is
defined under section 62A.671, subdivision 7.

deleted text begin (f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
 deleted text end

deleted text begin (1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
 deleted text end

deleted text begin (2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
 deleted text end

new text begin (f) Telemedicine visits, as described in this section, can be used to satisfy the face-to-face
requirement for consideration of reimbursement under the payment methods that apply to
a federally qualified health center, rural health clinic, Indian health service, 638 tribal clinic,
and certified community behavioral health clinic, if the service would have otherwise
qualified for payment if performed in person.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval.
 new text end

Sec. 5.

Minnesota Statutes 2020, section 256B.0625, subdivision 13, is amended to read:


Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissionerdeleted text begin .deleted text end new text begin or the drug appears on the 90-day supply list
published by the commissioner. The 90-day supply list shall be published by the
commissioner on the department's website. The commissioner may add to, delete from, and
otherwise modify the 90-day supply list after providing public notice and the opportunity
for a 15-day public comment period. The 90-day supply list may include cost-effective
generic drugs and shall not include controlled substances.
new text end

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.

Sec. 6.

Minnesota Statutes 2020, section 256B.0625, subdivision 13e, is amended to read:


Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The professional dispensing fee shall be
deleted text begin $10.48deleted text end new text begin $9.91new text end for prescriptions filled with legend drugs meeting the definition of "covered
outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The
dispensing fee for intravenous solutions that must be compounded by the pharmacist shall
be deleted text begin $10.48deleted text end new text begin $9.91new text end per deleted text begin bagdeleted text end new text begin claimnew text end . The professional dispensing fee for prescriptions filled with
over-the-counter drugs meeting the definition of covered outpatient drugs shall be deleted text begin $10.48deleted text end new text begin
$9.91new text end for dispensed quantities equal to or greater than the number of units contained in the
manufacturer's original package. The professional dispensing fee shall be prorated based
on the percentage of the package dispensed when the pharmacy dispenses a quantity less
than the number of units contained in the manufacturer's original package. The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units
contained in the manufacturer's original package and shall be prorated based on the
percentage of the package dispensed when the pharmacy dispenses a quantity less than the
number of units contained in the manufacturer's original package. The National Average
Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug.
For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient
cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for
a provider participating in the federal 340B Drug Pricing Program shall be either the 340B
Drug Pricing Program ceiling price established by the Health Resources and Services
Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as
the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in
the United States, not including prompt pay or other discounts, rebates, or reductions in
price, for the most recent month for which information is available, as reported in wholesale
price guides or other publications of drug or biological pricing data. The maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to
the actual acquisition cost of the drug product and no higher than the NADAC of the generic
product. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.

(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.

(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.

(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.

(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.

(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.

(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.

(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for all responding pharmacies to measure the
mean, mean weighted by total prescription volume, mean weighted by medical assistance
prescription volume, median, median weighted by total prescription volume, and median
weighted by total medical assistance prescription volume. The commissioner shall post a
copy of the final cost of dispensing survey report on the department's website. The initial
survey must be completed no later than January 1, 2021, and repeated every three years.
The commissioner shall provide a summary of the results of each cost of dispensing survey
and provide recommendations for any changes to the dispensing fee to the chairs and ranking
members of the legislative committees with jurisdiction over medical assistance pharmacy
reimbursement.

(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.

Sec. 7.

Minnesota Statutes 2020, section 256B.0625, subdivision 18, is amended to read:


Subd. 18.

deleted text begin Busdeleted text end new text begin Public transitnew text end or taxicab transportation.

new text begin (a) new text end To the extent authorized
by rule of the state agency, medical assistance covers the most appropriate and cost-effective
form of transportation incurred by any ambulatory eligible person for obtaining
nonemergency medical care.

new text begin (b) The commissioner may provide a monthly public transit pass to recipients who are
well-served by public transit for the recipient's nonemergency medical transportation needs.
Any recipient who is eligible for one public transit trip for a medically necessary covered
service may select to receive a transit pass for that month. Recipients who do not have any
transportation needs for a medically necessary service in any given month are not eligible
for a transit pass that month. The commissioner shall not require recipients to select a
monthly transit pass if the recipient's transportation needs cannot be served by public transit
systems. Recipients who receive a monthly transit pass are not eligible for other modes of
transportation, unless an unexpected need arises that cannot be accessed through public
transit.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
 new text end

Sec. 8.

Minnesota Statutes 2020, section 256B.0625, subdivision 58, is amended to read:


Subd. 58.

Early and periodic screening, diagnosis, and treatment services.

new text begin (a) new text end Medical
assistance covers early and periodic screening, diagnosis, and treatment services (EPSDT).
The payment amount for a complete EPSDT screening shall not include charges for health
care services and products that are available at no cost to the provider and shall not exceed
the rate established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.

new text begin (b) The commissioner may contract for the required EPSDT outreach services, including
but not limited to children enrolled or attributed to an integrated health partnership
demonstration project described in section 256B.0755. Integrated health partnerships that
choose to include the EPSDT outreach services within the integrated health partnership's
contracted responsibilities must receive compensation from the commissioner on a
per-member per-month basis for each included child. Integrated health partnerships must
accept responsibility for the effectiveness of outreach services it delivers. For children who
are not a part of the demonstration project, the commissioner may contract for the
administration of the outreach services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
 new text end

Sec. 9.

Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:


Subd. 6.

Service standards.

The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.

(a) The treatment team must use team treatment, not an individual treatment model.

(b) Services must be available at times that meet client needs.

(c) Services must be age-appropriate and meet the specific needs of the client.

(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.

(e) An individual treatment plan must:

(1) be based on the information in the client's diagnostic assessment and baselines;

(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;

(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;

(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;

(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;

(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;

(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;

(8) if a need for substance use disorder treatment is indicated by validated assessment:

(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;

(ii) be reviewed at least once every 90 days and revised, if necessary;

(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and

(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.

(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.

(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.

(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.

new text begin (i) The services and responsibilities of the psychiatric provider may be provided through
telemedicine when necessary to prevent disruption in client services or to maintain the
required psychiatric staffing level.
 new text end

Sec. 10.

Minnesota Statutes 2020, section 256B.0949, subdivision 13, is amended to read:


Subd. 13.

Covered services.

(a) The services described in paragraphs (b) to (l) are
eligible for reimbursement by medical assistance under this section. Services must be
provided by a qualified EIDBI provider and supervised by a QSP. An EIDBI service must
address the person's medically necessary treatment goals and must be targeted to develop,
enhance, or maintain the individual developmental skills of a person with ASD or a related
condition to improve functional communication, including nonverbal or social
communication, social or interpersonal interaction, restrictive or repetitive behaviors,
hyperreactivity or hyporeactivity to sensory input, behavioral challenges and self-regulation,
cognition, learning and play, self-care, and safety.

(b) EIDBI treatment must be delivered consistent with the standards of an approved
modality, as published by the commissioner. EIDBI modalities include:

(1) applied behavior analysis (ABA);

(2) developmental individual-difference relationship-based model (DIR/Floortime);

(3) early start Denver model (ESDM);

(4) PLAY project;

(5) relationship development intervention (RDI); or

(6) additional modalities not listed in clauses (1) to (5) upon approval by the
commissioner.

(c) An EIDBI provider may use one or more of the EIDBI modalities in paragraph (b),
clauses (1) to (5), as the primary modality for treatment as a covered service, or several
EIDBI modalities in combination as the primary modality of treatment, as approved by the
commissioner. An EIDBI provider that identifies and provides assurance of qualifications
for a single specific treatment modality must document the required qualifications to meet
fidelity to the specific model.

(d) Each qualified EIDBI provider must identify and provide assurance of qualifications
for professional licensure certification, or training in evidence-based treatment methods,
and must document the required qualifications outlined in subdivision 15 in a manner
determined by the commissioner.

(e) CMDE is a comprehensive evaluation of the person's developmental status to
determine medical necessity for EIDBI services and meets the requirements of subdivision
5. The services must be provided by a qualified CMDE provider.

(f) EIDBI intervention observation and direction is the clinical direction and oversight
of EIDBI services by the QSP, level I treatment provider, or level II treatment provider,
including developmental and behavioral techniques, progress measurement, data collection,
function of behaviors, and generalization of acquired skills for the direct benefit of a person.
EIDBI intervention observation and direction informs any modification of the current
treatment protocol to support the outcomes outlined in the ITP.

(g) Intervention is medically necessary direct treatment provided to a person with ASD
or a related condition as outlined in their ITP. All intervention services must be provided
under the direction of a QSP. Intervention may take place across multiple settings. The
frequency and intensity of intervention services are provided based on the number of
treatment goals, person and family or caregiver preferences, and other factors. Intervention
services may be provided individually or in a group. Intervention with a higher provider
ratio may occur when deemed medically necessary through the person's ITP.

(1) Individual intervention is treatment by protocol administered by a single qualified
EIDBI provider delivered deleted text begin face-to-facedeleted text end to one person.

(2) Group intervention is treatment by protocol provided by one or more qualified EIDBI
providers, delivered to at least two people who receive EIDBI services.

(h) ITP development and ITP progress monitoring is development of the initial, annual,
and progress monitoring of an ITP. ITP development and ITP progress monitoring documents
provide oversight and ongoing evaluation of a person's treatment and progress on targeted
goals and objectives and integrate and coordinate the person's and the person's legal
representative's information from the CMDE and ITP progress monitoring. This service
must be reviewed and completed by the QSP, and may include input from a level I provider
or a level II provider.

(i) Family caregiver training and counseling is specialized training and education for a
family or primary caregiver to understand the person's developmental status and help with
the person's needs and development. This service must be provided by the QSP, level I
provider, or level II provider.

(j) A coordinated care conference is a voluntary deleted text begin face-to-facedeleted text end meeting with the person
and the person's family to review the CMDE or ITP progress monitoring and to integrate
and coordinate services across providers and service-delivery systems to develop the ITP.
This service must be provided by the QSP and may include the CMDE provider or a level
I provider or a level II provider.

(k) Travel time is allowable billing for traveling to and from the person's home, school,
a community setting, or place of service outside of an EIDBI center, clinic, or office from
a specified location to provide deleted text begin face-to-facedeleted text end new text begin in-personnew text end EIDBI intervention, observation and
direction, or family caregiver training and counseling. The person's ITP must specify the
reasons the provider must travel to the person.

(l) Medical assistance covers medically necessary EIDBI services and consultations
delivered by a licensed health care provider via telemedicine, as defined under section
256B.0625, subdivision 3b, in the same manner as if the service or consultation was delivered
in person.

Sec. 11.

Minnesota Statutes 2020, section 256B.75, is amended to read:


256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.

(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.

(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2017, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.

(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.new text begin
When implementing prospective payment methodologies, the commissioner shall use general
methods and rate calculation parameters similar to the applicable Medicare prospective
payment systems for services delivered in outpatient hospital and ambulatory surgical center
settings unless other payment methodologies for these services are specified in this chapter.
new text end

(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.

(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.

(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.

Sec. 12.

Minnesota Statutes 2020, section 256B.79, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

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

(b) "Adverse outcomes" means maternal opiate addiction, other reportable prenatal
substance abuse, low birth weight, or preterm birth.

(c) "Qualified integrated perinatal care collaborative" or "collaborative" means a
combination of (1) members of community-based organizations that represent communities
within the identified targeted populations, and (2) local or tribally based service entities,
including health care, public health, social services, mental health, chemical dependency
treatment, and community-based providers, determined by the commissioner to meet the
criteria for the provision of integrated care and enhanced services for enrollees within
targeted populations.

(d) "Targeted populations" means pregnant medical assistance enrollees residing in
deleted text begin geographic areasdeleted text end new text begin communitiesnew text end identified by the commissioner as being at above-average
risk for adverse outcomes.

Sec. 13.

Minnesota Statutes 2020, section 256B.79, subdivision 3, is amended to read:


Subd. 3.

Grant awards.

The commissioner shall award grants to qualifying applicants
to support interdisciplinary, integrated perinatal care. Grant funds must be distributed through
a request for proposals process to a designated lead agency within an entity that has been
determined to be a qualified integrated perinatal care collaborative or within an entity in
the process of meeting the qualifications to become a qualified integrated perinatal care
collaborativedeleted text begin , and priority shall be given to qualified integrated perinatal care collaboratives
that received grants under this section prior to January 1, 2019deleted text end . Grant awards must be used
to support interdisciplinary, team-based needs assessments, planning, and implementation
of integrated care and enhanced services for targeted populations. In determining grant
award amounts, the commissioner shall consider the identified health and social risks linked
to adverse outcomes and attributed to enrollees within the identified targeted population.

Sec. 14.

Minnesota Statutes 2020, section 256L.01, subdivision 5, is amended to read:


Subd. 5.

Income.

"Income" has the meaning given for modified adjusted gross income,
as defined in Code of Federal Regulations, title 26, section 1.36B-1, and means a household's
deleted text begin current income, or if income fluctuates month to month, the income for the 12-month
eligibility perioddeleted text end new text begin projected annual income for the applicable tax yearnew text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 15.

Minnesota Statutes 2020, section 256L.04, subdivision 7b, is amended to read:


Subd. 7b.

Annual income limits adjustment.

The commissioner shall adjust the income
limits under this section annually deleted text begin each July 1deleted text end new text begin on January 1new text end as deleted text begin described in section 256B.056,
subdivision 1cdeleted text end new text begin provided in Code of Federal Regulations, title 26, section 1.36B-1(h)new text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 16.

Minnesota Statutes 2020, section 256L.05, subdivision 3a, is amended to read:


Subd. 3a.

Redetermination of eligibility.

(a) An enrollee's eligibility must be
redetermined on an annual basisdeleted text begin , in accordance with Code of Federal Regulations, title 42,
section 435.916 (a). The 12-month eligibility period begins the month of application.
Beginning July 1, 2017, the commissioner shall adjust the eligibility period for enrollees to
implement renewals throughout the year according to guidance from the Centers for Medicare
and Medicaid Servicesdeleted text end .new text begin The period of eligibility is the entire calendar year following the
year in which eligibility is redetermined. Eligibility redeterminations shall occur during the
open enrollment period for qualified health plans as specified in Code of Federal Regulations,
title 45, section 155.410(e)(3).
new text end

(b) Each new period of eligibility must take into account any changes in circumstances
that impact eligibility and premium amount. Coverage begins as provided in section 256L.06.

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 5

LICENSING AND BACKGROUND STUDIES

Section 1.

Minnesota Statutes 2020, section 62V.05, is amended by adding a subdivision
to read:


new text begin Subd. 4a. new text end

new text begin Background study required. new text end

new text begin (a) The board must initiate background studies
under chapter 245C of:
 new text end

new text begin (1) each navigator;
 new text end

new text begin (2) each in-person assister; and
 new text end

new text begin (3) each certified application counselor.
 new text end

new text begin (b) The board must initiate the background studies required by paragraph (a) using the
online NETStudy 2.0 system operated by the commissioner of human services.
 new text end

new text begin (c) The board shall not permit any individual to provide any service or function listed
in paragraph (a) until the board has received notification from the commissioner of human
services indicating that the individual:
 new text end

new text begin (1) is not disqualified under chapter 245C; or
 new text end

new text begin (2) is disqualified, but has received a set aside from the board of that disqualification
according to sections 245C.22 and 245C.23.
 new text end

new text begin (d) The board or its delegate shall review a reconsideration request of an individual in
paragraph (a), including granting a set aside, according to the procedures and criteria in
chapter 245C. The board shall notify the individual and the Department of Human Services
of the board's decision.
 new text end

Sec. 2.

Minnesota Statutes 2020, section 122A.18, subdivision 8, is amended to read:


Subd. 8.

Background deleted text begin checksdeleted text end new text begin studiesnew text end .

(a) The Professional Educator Licensing and
Standards Board and the Board of School Administrators must deleted text begin obtain adeleted text end new text begin initiatenew text end criminal
history background deleted text begin check ondeleted text end new text begin studies ofnew text end all first-time deleted text begin teachingdeleted text end applicants for new text begin educator new text end licenses
under their jurisdiction. Applicants must include with their licensure applications:

(1) an executed criminal history consent form, including fingerprints; and

(2) payment to conduct the background check. The Professional Educator Licensing and
Standards Board must deposit payments received under this subdivision in an account in
the special revenue fund. Amounts in the account are annually appropriated to the
Professional Educator Licensing and Standards Board to pay for the costs of background
checks on applicants for licensure.

(b) The background check for all first-time teaching applicants for licenses must include
a review of information from the Bureau of Criminal Apprehension, including criminal
history data as defined in section 13.87, and must also include a review of the national
criminal records repository. The superintendent of the Bureau of Criminal Apprehension
is authorized to exchange fingerprints with the Federal Bureau of Investigation for purposes
of the criminal history check. The superintendent shall recover the cost to the bureau of a
background check through the fee charged to the applicant under paragraph (a).

(c) The Professional Educator Licensing and Standards Board deleted text begin must contract withdeleted text end new text begin may
initiate criminal history background studies throughnew text end the commissioner of human services
new text begin according to section 245C.031 new text end to deleted text begin conduct background checks anddeleted text end obtain background check
data required under this chapter.

Sec. 3.

Minnesota Statutes 2020, section 245A.10, subdivision 4, is amended to read:


Subd. 4.

License or certification fee for certain programs.

(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:

Licensed Capacity
 Child Care Center
License Fee
1 to 24 persons
 $200
25 to 49 persons
 $300
50 to 74 persons
 $400
75 to 99 persons
 $500
100 to 124 persons
 $600
125 to 149 persons
 $700
150 to 174 persons
 $800
175 to 199 persons
 $900
200 to 224 persons
 $1,000
225 or more persons
 $1,100

(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:

License Holder Annual Revenue
 License Fee
less than or equal to $10,000
 $200
greater than $10,000 but less than or
equal to $25,000
 $300
greater than $25,000 but less than or
equal to $50,000
 $400
greater than $50,000 but less than or
equal to $100,000
 $500
greater than $100,000 but less than or
equal to $150,000
 $600
greater than $150,000 but less than or
equal to $200,000
 $800
greater than $200,000 but less than or
equal to $250,000
 $1,000
greater than $250,000 but less than or
equal to $300,000
 $1,200
greater than $300,000 but less than or
equal to $350,000
 $1,400
greater than $350,000 but less than or
equal to $400,000
 $1,600
greater than $400,000 but less than or
equal to $450,000
 $1,800
greater than $450,000 but less than or
equal to $500,000
 $2,000
greater than $500,000 but less than or
equal to $600,000
 $2,250
greater than $600,000 but less than or
equal to $700,000
 $2,500
greater than $700,000 but less than or
equal to $800,000
 $2,750
greater than $800,000 but less than or
equal to $900,000
 $3,000
greater than $900,000 but less than or
equal to $1,000,000
 $3,250
greater than $1,000,000 but less than or
equal to $1,250,000
 $3,500
greater than $1,250,000 but less than or
equal to $1,500,000
 $3,750
greater than $1,500,000 but less than or
equal to $1,750,000
 $4,000
greater than $1,750,000 but less than or
equal to $2,000,000
 $4,250
greater than $2,000,000 but less than or
equal to $2,500,000
 $4,500
greater than $2,500,000 but less than or
equal to $3,000,000
 $4,750
greater than $3,000,000 but less than or
equal to $3,500,000
 $5,000
greater than $3,500,000 but less than or
equal to $4,000,000
 $5,500
greater than $4,000,000 but less than or
equal to $4,500,000
 $6,000
greater than $4,500,000 but less than or
equal to $5,000,000
 $6,500
greater than $5,000,000 but less than or
equal to $7,500,000
 $7,000
greater than $7,500,000 but less than or
equal to $10,000,000
 $8,500
greater than $10,000,000 but less than or
equal to $12,500,000
 $10,000
greater than $12,500,000 but less than or
equal to $15,000,000
 $14,000
greater than $15,000,000
 $18,000

(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.

(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.

(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.

(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).

(c) A chemical dependency treatment program licensed under chapter 245G, to provide
chemical dependency treatment shall pay an annual nonrefundable license fee based on the
following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $600
25 to 49 persons
 $800
50 to 74 persons
 $1,000
75 to 99 persons
 $1,200
100 or more persons
 $1,400

(d) A deleted text begin chemical dependencydeleted text end new text begin detoxificationnew text end program licensed under Minnesota Rules,
parts 9530.6510 to 9530.6590, deleted text begin to provide detoxification servicesdeleted text end new text begin or a withdrawal management
program licensed under chapter 245Fnew text end shall pay an annual nonrefundable license fee based
on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $760
25 to 49 persons
 $960
50 or more persons
 $1,160

new text begin A detoxification program that also operates a withdrawal management program at the same
location shall only pay one fee based upon the licensed capacity of the program with the
higher overall capacity.
 new text end

(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $1,000
25 to 49 persons
 $1,100
50 to 74 persons
 $1,200
75 to 99 persons
 $1,300
100 or more persons
 $1,400

(f) A residential facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670,
to serve persons with mental illness shall pay an annual nonrefundable license fee based on
the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $2,525
25 or more persons
 $2,725

(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $450
25 to 49 persons
 $650
50 to 74 persons
 $850
75 to 99 persons
 $1,050
100 or more persons
 $1,250

(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.

(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.

(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $500
25 to 49 persons
 $700
50 to 74 persons
 $900
75 to 99 persons
 $1,100
100 or more persons
 $1,300

(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.

(l) A mental health center or mental health clinic requesting certification for purposes
of insurance and subscriber contract reimbursement under Minnesota Rules, parts 9520.0750
to 9520.0870, shall pay a certification fee of $1,550 per year. If the mental health center or
mental health clinic provides services at a primary location with satellite facilities, the
satellite facilities shall be certified with the primary location without an additional charge.

Sec. 4.

Minnesota Statutes 2020, section 245C.02, is amended by adding a subdivision to
read:


new text begin Subd. 5b. new text end

new text begin Alternative background study. new text end

new text begin "Alternative background study" means a
review of records conducted by the commissioner pursuant to section 245C.08 in order to
forward the background study investigating information to the entity that submitted the
alternative background study request under section 245C.031, subdivision 2. The
commissioner shall not make any eligibility determinations on background studies conducted
under section 245C.031.
 new text end

Sec. 5.

Minnesota Statutes 2020, section 245C.02, is amended by adding a subdivision to
read:


new text begin Subd. 11c. new text end

new text begin Entity. new text end

new text begin "Entity" means any program or organization initiating a background
study.
 new text end

Sec. 6.

Minnesota Statutes 2020, section 245C.02, is amended by adding a subdivision to
read:


new text begin Subd. 16a. new text end

new text begin Results. new text end

new text begin "Results" means a determination that a study subject is eligible,
disqualified, set aside, granted a variance, or that more time is needed to complete the
background study.
 new text end

Sec. 7.

Minnesota Statutes 2020, section 245C.03, is amended to read:


245C.03 BACKGROUND STUDY; INDIVIDUALS TO BE STUDIED.

Subdivision 1.

Licensed programs.

(a) The commissioner shall conduct a background
study on:

(1) the person or persons applying for a license;

(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;

(3) current or prospective employees or contractors of the applicant who will have direct
contact with persons served by the facility, agency, or program;

(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);

(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;

(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;

(7) all controlling individuals as defined in section 245A.02, subdivision 5a;

(8) notwithstanding the other requirements in this subdivision, child care background
study subjects as defined in section 245C.02, subdivision 6a; and

(9) notwithstanding clause (3), for children's residential facilities and foster residence
settings, any adult working in the facility, whether or not the individual will have direct
contact with persons served by the facility.

(b) For child foster care when the license holder resides in the home where foster care
services are provided, a short-term substitute caregiver providing direct contact services for
a child for less than 72 hours of continuous care is not required to receive a background
study under this chapter.

new text begin Subd. 1a. new text end

new text begin Procedure. new text end

new text begin (a) Individuals and organizations that are required under this
section to have or initiate background studies shall comply with the requirements of this
chapter.
 new text end

new text begin (b) All studies conducted under this section shall be conducted according to sections
299C.60 to 299C.64. This requirement does not apply to subdivisions 1, 4, 6a, 9, and 9a.
 new text end

Subd. 2.

Personal care provider organizations.

The commissioner shall conduct
background studies on any individual required under sections 256B.0651 to 256B.0654 and
256B.0659 to have a background study completed under this chapter.

Subd. 3.

Supplemental nursing services agencies.

The commissioner shall conduct all
background studies required under this chapter and initiated by supplemental nursing services
agencies registered under section 144A.71, subdivision 1.

new text begin Subd. 3a. new text end

new text begin Exception to personal care assistant; requirements. new text end

new text begin The personal care
assistant for a recipient may be allowed to enroll with a different personal care assistant
provider agency upon initiation of a new background study according to this chapter if:
 new text end

new text begin (1) the commissioner determines that a change in enrollment or affiliation of the personal
care assistant is needed in order to ensure continuity of services and protect the health and
safety of the recipient;
 new text end

new text begin (2) the chosen agency has been continuously enrolled as a personal care assistance
provider agency for at least two years;
 new text end

new text begin (3) the recipient chooses to transfer to the personal care assistance provider agency;
 new text end

new text begin (4) the personal care assistant has been continuously enrolled with the former personal
care assistance provider agency since the last background study was completed; and
 new text end

new text begin (5) the personal care assistant continues to meet requirements of Minnesota Statutes,
section 256B.0659, subdivision 11, notwithstanding paragraph (a), clause (3).
 new text end

new text begin Subd. 3b. new text end

new text begin Personal care assistance provider agency; background studies. new text end

new text begin Personal
care assistance provider agencies enrolled to provide personal care assistance services under
the medical assistance program must meet the following requirements:
 new text end

new text begin (1) owners who have a five percent interest or more and all managing employees are
subject to a background study as provided in this chapter. This requirement applies to
currently enrolled personal care assistance provider agencies and agencies seeking enrollment
as a personal care assistance provider agency. "Managing employee" has the same meaning
as Code of Federal Regulations, title 42, section 455. An organization is barred from
enrollment if:
 new text end

new text begin (i) the organization has not initiated background studies of owners and managing
employees; or
 new text end

new text begin (ii) the organization has initiated background studies of owners and managing employees
and the commissioner has sent the organization a notice that an owner or managing employee
of the organization has been disqualified under section 245C.14, and the owner or managing
employee has not received a set aside of the disqualification under section 245C.22; and
 new text end

new text begin (2) a background study must be initiated and completed for all qualified professionals.
 new text end

Subd. 4.

Personnel agencies; educational programs; professional services
agencies.

The commissioner also may conduct studies on individuals specified in subdivision
1, paragraph (a), clauses (3) and (4), when the studies are initiated by:

(1) personnel pool agencies;

(2) temporary personnel agencies;

(3) educational programs that train individuals by providing direct contact services in
licensed programs; and

(4) professional services agencies that are not licensed and which contract with licensed
programs to provide direct contact services or individuals who provide direct contact services.

Subd. 5.

Other state agencies.

The commissioner shall conduct background studies on
applicants and license holders under the jurisdiction of other state agencies who are required
in other statutory sections to initiate background studies under this chapter, including the
applicant's or license holder's employees, contractors, and volunteers when required under
other statutory sections.

new text begin Subd. 5a. new text end

new text begin Facilities serving children or adults licensed or regulated by the
Department of Health. new text end

new text begin (a) The commissioner of health shall contract with the commissioner
of human services to conduct background studies of:
 new text end

new text begin (1) individuals providing services who have direct contact, as defined under section
245C.02, subdivision 11, with patients and residents in hospitals, boarding care homes,
outpatient surgical centers licensed under sections 144.50 to 144.58; nursing homes and
home care agencies licensed under chapter 144A; assisted living facilities and assisted living
facilities with dementia care licensed under chapter 144G; and board and lodging
establishments that are registered to provide supportive or health supervision services under
section 157.17;
 new text end

new text begin (2) individuals specified in section 245C.03, subdivision 1, who provide direct contact
services in a nursing home or a home care agency licensed under chapter 144A; an assisted
living facility or assisted living facility with dementia care licensed under chapter 144G;
or a boarding care home licensed under sections 144.50 to 144.58. If the individual
understudy resides outside of Minnesota, the study must include a check for substantiated
findings of maltreatment of adults and children in the individual's state of residence when
the state makes the information available;
 new text end

new text begin (3) all other employees in assisted living facilities or assisted living facilities with
dementia care licensed under chapter 144G, nursing homes licensed under chapter 144A,
and boarding care homes licensed under sections 144.50 to 144.58. A disqualification of
an individual in this section shall disqualify the individual from positions allowing direct
contact with or access to patients or residents receiving services. "Access" means physical
access to a client or the client's personal property without continuous, direct supervision as
defined in section 245C.02, subdivision 8, when the employee's employment responsibilities
do not include providing direct contact services;
 new text end

new text begin (4) individuals employed by a supplemental nursing services agency, as defined under
section 144A.70, who are providing services in health care facilities; and
 new text end

new text begin (5) controlling persons of a supplemental nursing services agency, as defined by section
144A.70.
 new text end

new text begin (b) If a facility or program is licensed by the Department of Human Services and the
Department of Health and is subject to the background study provisions of this chapter, the
Department of Human Services is solely responsible for the background studies of individuals
in the jointly licensed program.
 new text end

new text begin Subd. 5b. new text end

new text begin Facilities serving children or youth licensed by the Department of
Corrections. new text end

new text begin (a) The commissioner shall conduct background studies of individuals providing
services in secure and nonsecure residential facilities and detention facilities who have direct
contact, as defined under section 245C.02, subdivision 11, with persons served in the
facilities.
 new text end

new text begin (b) A clerk or administrator of any court, the Bureau of Criminal Apprehension, a
prosecuting attorney, a county sheriff, or a chief of a local police department shall assist in
conducting background studies by providing the commissioner of human services or the
commissioner's representative with all criminal conviction data available from local, state,
and national criminal history record repositories, related to applicants, operators, all persons
living in a household, and all staff of any facility subject to background studies under this
subdivision.
 new text end

new text begin (c) For the purpose of this subdivision, the term "secure and nonsecure residential facility
and detention facility" includes programs licensed or certified under section 241.021,
subdivision 2.
 new text end

new text begin (d) If an individual is disqualified, the Department of Human Services shall notify the
disqualified individual and the facility in which the disqualified individual provides services
and shall inform the disqualified individual of the right to request a reconsideration of the
disqualification by submitting the request to the Department of Corrections.
 new text end

new text begin (e) The commissioner of corrections shall review and make decisions regarding
reconsideration requests, including whether to grant variances, according to the procedures
and criteria in this chapter. The commissioner of corrections shall inform the requesting
individual and the Department of Human Services of the commissioner's decision. The
commissioner's decision to grant or deny a reconsideration of a disqualification is the final
administrative agency action.
 new text end

Subd. 6.

Unlicensed home and community-based waiver providers of service to
seniors and individuals with disabilities.

The commissioner shall conduct background
studies deleted text begin ondeleted text end new text begin ofnew text end any individual deleted text begin required under section 256B.4912 to have a background study
completed under this chapterdeleted text end new text begin who provides direct contact, as defined in section 245C.02,
subdivision 11, for services specified in the federally approved home and community-based
waiver plans under section 256B.4712 and the individual studied must meet the requirements
of this chapter prior to providing waiver services and as part of ongoing enrollment. Upon
federal approval, this requirement applies to consumer-directed community supportsnew text end .

Subd. 6a.

Legal nonlicensed and certified child care programs.

The commissioner
shall conduct background studies deleted text begin on an individualdeleted text end new text begin of the following individuals asnew text end required
deleted text begin underdeleted text end new text begin bynew text end sections 119B.125 and 245H.10 deleted text begin to complete a background study under this chapter.deleted text end new text begin :
new text end

new text begin (1) every individual who applies for certification;
 new text end

new text begin (2) every member of a provider's household who is age 13 and older; and
 new text end

new text begin (3) an individual who is at least ten years of age and under 13 years of age and lives in
the household where the nonlicensed child care will be provided when the county has
reasonable cause as defined under section 245C.02, subdivision 15.
 new text end

Subd. 7.

Children's therapeutic services and supports providers.

The commissioner
shall conduct background studies deleted text begin according to this chapter when initiated by a children's
therapeutic services and supports providerdeleted text end new text begin of all direct service providers and volunteers for
children's therapeutic services and supports providersnew text end under section 256B.0943.

Subd. 8.

Self-initiated background studies.

Upon implementation of NETStudy 2.0,
the commissioner shall conduct background studies according to this chapter when initiated
by an individual who is not on the master roster. A subject under this subdivision who is
not disqualified must be placed on the inactive roster.

Subd. 9.

Community first services and supports organizations.

deleted text begin The commissioner
shall conduct background studies on any individual required under section 256B.85 to have
a background study completed under this chapter. deleted text end new text begin Individuals affiliated with Community
First Services and Supports (CFSS) agency-providers and Financial Management Services
(FMS) providers enrolled to provide CFSS services under the medical assistance program
must meet the following requirements:
 new text end

new text begin (1) owners who have a five percent interest or more and all managing employees are
subject to a background study under this chapter. This requirement applies to currently
enrolled providers and agencies seeking enrollment. "Managing employee" has the meaning
given in Code of Federal Regulations, title 42, section 455.101. An organization is barred
from enrollment if:
 new text end

new text begin (i) the organization has not initiated background studies of owners and managing
employees; or
 new text end

new text begin (ii) the organization has initiated background studies of owners and managing employees
and the commissioner has sent the organization a notice that an owner or managing employee
of the organization has been disqualified under section 245C.14 and the owner or managing
employee has not received a set aside of the disqualification under section 245C.22;
 new text end

new text begin (2) a background study must be initiated and completed for all staff who will have direct
contact with the participant to provide worker training and development; and
 new text end

new text begin (3) a background study must be initiated and completed for all support workers.
 new text end

new text begin Subd. 9a. new text end

new text begin Exception to support worker requirements for continuity of services. new text end

new text begin The
support worker for a participant may enroll with a different Community First Services and
Supports (CFSS) agency-provider or Financial Management Services (FMS) provider upon
initiation, rather than completion, of a new background study according to this chapter if:
 new text end

new text begin (1) the commissioner determines that the support worker's change in enrollment or
affiliation is necessary to ensure continuity of services and to protect the health and safety
of the participant;
 new text end

new text begin (2) the chosen agency-provider or FMS provider has been continuously enrolled as a
CFSS agency-provider or FMS provider for at least two years or since the inception of the
CFSS program, whichever is shorter;
 new text end

new text begin (3) the participant served by the support worker chooses to transfer to the CFSS
agency-provider or the FMS provider to which the support worker is transferring;
 new text end

new text begin (4) the support worker has been continuously enrolled with the former CFSS
agency-provider or FMS provider since the support worker's last background study was
completed; and
 new text end

new text begin (5) the support worker continues to meet the requirements of section 256B.85, subdivision
16, notwithstanding paragraph (a), clause (1).
 new text end

Subd. 10.

Providers of group residential housing or supplementary services.

new text begin (a) new text end The
commissioner shall conduct background studies deleted text begin on any individual required under section
256I.04 to have a background study completed under this chapter.deleted text end new text begin of the following individuals
who provide services under section 256I.04:
new text end

new text begin (1) controlling individuals as defined in section 245A.02;
 new text end

new text begin (2) managerial officials as defined in section 245A.02; and
 new text end

new text begin (3) all employees and volunteers of the establishment who have direct contact with
recipients or who have unsupervised access to recipients, recipients' personal property, or
recipients' private data.
 new text end

new text begin (b) The provider of housing support must comply with all requirements for entities
initiating background studies under this chapter.
 new text end

new text begin (c) A provider of housing support must demonstrate that all individuals who are required
to have a background study according to paragraph (a) have a notice stating that:
 new text end

new text begin (1) the individual is not disqualified under section 245C.14; or
 new text end

new text begin (2) the individual is disqualified and the individual has been issued a set aside of the
disqualification for the setting under section 245C.22.
 new text end

deleted text begin Subd. 11. deleted text end

deleted text begin Child protection workers or social services staff having responsibility for
child protective duties. deleted text end

deleted text begin (a) The commissioner must complete background studies, according
to paragraph (b) and section 245C.04, subdivision 10, when initiated by a county social
services agency or by a local welfare agency according to section 626.559, subdivision 1b.
 deleted text end

deleted text begin (b) For background studies completed by the commissioner under this subdivision, the
commissioner shall not make a disqualification decision, but shall provide the background
study information received to the county that initiated the study.
 deleted text end

Subd. 12.

Providers of special transportation service.

new text begin (a) new text end The commissioner shall
conduct background studies deleted text begin on any individual required under section 174.30 to have a
background study completed under this chapter.deleted text end new text begin of the following individuals who provide
special transportation services under section 174.30:
new text end

new text begin (1) each person with a direct or indirect ownership interest of five percent or higher in
a transportation service provider;
 new text end

new text begin (2) each controlling individual as defined under section 245A.02;
 new text end

new text begin (3) a managerial official as defined in section 245A.02;
 new text end

new text begin (4) each driver employed by the transportation service provider;
 new text end

new text begin (5) each individual employed by the transportation service provider to assist a passenger
during transport; and
 new text end

new text begin (6) each employee of the transportation service agency who provides administrative
support, including an employee who:
 new text end

new text begin (i) may have face-to-face contact with or access to passengers, passengers' personal
property, or passengers' private data;
 new text end

new text begin (ii) performs any scheduling or dispatching tasks; or
 new text end

new text begin (iii) performs any billing activities.
 new text end

new text begin (b) When a local or contracted agency is authorizing a ride under section 256B.0625,
subdivision 17, by a volunteer driver, and the agency authorizing the ride has a reason to
believe that the volunteer driver has a history that would disqualify the volunteer driver or
that may pose a risk to the health or safety of passengers, the agency may initiate a
background study that shall be completed according to this chapter using the commissioner
of human services' online NETStudy system, or by contacting the Department of Human
Services background study division for assistance. The agency that initiates the background
study under this paragraph shall be responsible for providing the volunteer driver with the
privacy notice required by section 245C.05, subdivision 2c, and with the payment for the
background study required by section 245C.10 before the background study is completed.
 new text end

Subd. 13.

Providers of housing support services.

The commissioner shall conduct
background studies deleted text begin ondeleted text end new text begin ofnew text end any deleted text begin individualdeleted text end new text begin provider of housing support servicesnew text end required deleted text begin underdeleted text end new text begin
bynew text end section 256B.051 to have a background study completed under this chapter.

new text begin Subd. 14. new text end

new text begin Tribal nursing facilities. new text end

new text begin For completed background studies to comply with
a tribal organization's licensing requirements for individuals affiliated with a tribally licensed
nursing facility, the commissioner shall obtain state and national criminal history data
according to section 245C.32.
 new text end

Sec. 8.

new text begin [245C.031] BACKGROUND STUDY; ALTERNATIVE BACKGROUND
STUDIES.
 new text end

new text begin Subdivision 1. new text end

new text begin Alternative background studies. new text end

new text begin (a) The commissioner shall conduct
an alternative background study of individuals listed in this section.
 new text end

new text begin (b) Notwithstanding other sections of this chapter, all alternative background studies
except subdivision 9 shall be conducted according to this section and with section 299C.60
to 299C.64.
 new text end

new text begin (c) All terms in this section shall have the definitions provided in section 245C.02.
 new text end

new text begin (d) The entity that submits an alternative background study request under this section
shall submit the request to the commissioner according to section 245C.05.
 new text end

new text begin (e) The commissioner shall comply with the destruction requirements in section 245C.051.
 new text end

new text begin (f) Background studies conducted under this section are subject to the provisions of
section 245C.32.
 new text end

new text begin (g) The commissioner shall forward all information that the commissioner receives under
section 245C.08 to the entity that submitted the alternative background study request under
subdivision 2. The commissioner shall not make any eligibility determinations regarding
background studies conducted under this section.
 new text end

new text begin Subd. 2. new text end

new text begin Access to information. new text end

new text begin Each entity that submits an alternative background
study request shall enter into an agreement with the commissioner before submitting requests
for alternative background studies under this section. As a part of the agreement, the entity
must agree to comply with state and federal law.
 new text end

new text begin Subd. 3. new text end

new text begin Child protection workers or social services staff having responsibility for
child protective duties. new text end

new text begin The commissioner shall conduct an alternative background study
of any person who has responsibility for child protection duties when the background study
is initiated by a county social services agency or by a local welfare agency according to
section 260E.36, subdivision 3.
 new text end

new text begin Subd. 4. new text end

new text begin Applicants, licensees, and other occupations regulated by the commissioner
of health. new text end

new text begin The commissioner shall conduct an alternative background study, including a
check of state data, and a national criminal history records check of the following individuals.
The check must be structured so that any new crimes that an applicant or licensee or
certificate holder commits after the initial background check are flagged in the Bureau of
Criminal Apprehension's or Federal Bureau of Investigation's database and reported to the
commissioner of human services. For studies under this section, the following persons shall
complete a consent form:
 new text end

new text begin (1) an applicant for initial licensure, temporary licensure, or relicensure after a lapse in
licensure as an audiologist or speech-language pathologist or an applicant for initial
certification as a hearing instrument dispenser who must submit to a background study
under section 144.0572.
 new text end

new text begin (2) an applicant for a renewal license or certificate as an audiologist, speech-language
pathologist, or hearing instrument dispenser who was licensed or obtained a certificate
before January 1, 2018.
 new text end

new text begin Subd. 5. new text end

new text begin Guardians and conservators. new text end

new text begin (a) The commissioner shall conduct an alternative
background study of:
 new text end

new text begin (1) every court-appointed guardian and conservator, unless a background study has been
completed of the person under this section within the previous five years. The alternative
background study shall be completed prior to the appointment of the guardian or conservator,
unless a court determines that it would be in the best interests of the ward or protected person
to appoint a guardian or conservator before the alternative background study can be
completed. If the court appoints the guardian or conservator while the alternative background
study is pending, the alternative background study must be completed as soon as reasonably
possible after the guardian or conservator's appointment and no later than 30 days after the
guardian or conservator's appointment; and
 new text end

new text begin (2) a guardian and a conservator once every five years after the guardian or conservator's
appointment if the person continues to serve as a guardian or conservator.
 new text end

new text begin (b) An alternative background study is not required if the guardian or conservator is:
 new text end

new text begin (1) a state agency or county;
 new text end

new text begin (2) a parent or guardian of a proposed ward or protected person who has a developmental
disability if the parent or guardian has raised the proposed ward or protected person in the
family home until the time that the petition is filed, unless counsel appointed for the proposed
ward or protected person under section 524.5-205, paragraph (d); 524.5-304, paragraph (b);
524.5-405, paragraph (a); or 524.5-406, paragraph (b), recommends a background study;
or
 new text end

new text begin (3) a bank with trust powers, a bank and trust company, or a trust company, organized
under the laws of any state or of the United States and regulated by the commissioner of
commerce or a federal regulator.
 new text end

new text begin Subd. 6. new text end

new text begin Required checks. new text end

new text begin (a) An alternative background study pursuant to subdivision
5 shall include:
 new text end

new text begin (1) criminal history data from the Bureau of Criminal Apprehension and other criminal
history data held by the commissioner of human services;
 new text end

new text begin (2) data regarding whether the person has been a perpetrator of substantiated maltreatment
of a vulnerable adult under section 626.557 or a minor under chapter 260E. If the subject
of the study has been the perpetrator of substantiated maltreatment of a vulnerable adult or
a minor, the commissioner must include a copy of the public portion of the investigation
memorandum under section 626.557, subdivision 12b, or the public portion of the
investigation memorandum under section 260E.30. The commissioner shall provide the
court with information from a review of information according to subdivision 7 if the study
subject provided information that the study subject has a current or prior affiliation with a
state licensing agency;
 new text end

new text begin (3) criminal history data from a national criminal history record check as defined in
section 245C.02, subdivision 13c; and
 new text end

new text begin (4) state licensing agency data if a search of the database or databases of the agencies
listed in subdivision 7 shows that the proposed guardian or conservator has held a
professional license directly related to the responsibilities of a professional fiduciary from
an agency listed in subdivision 7 that was conditioned, suspended, revoked, or canceled.
 new text end

new text begin (b) If the guardian or conservator is not an individual, the background study must be
completed of all individuals who are currently employed by the proposed guardian or
conservator who are responsible for exercising powers and duties under the guardianship
or conservatorship.
 new text end

new text begin Subd. 7. new text end

new text begin State licensing data. new text end

new text begin (a) Within 25 working days of receiving the request, the
commissioner shall provide the court with licensing agency data for licenses directly related
to the responsibilities of a professional fiduciary if the study subject has a current or prior
affiliation with the:
 new text end

new text begin (1) Lawyers Responsibility Board;
 new text end

new text begin (2) State Board of Accountancy;
 new text end

new text begin (3) Board of Social Work;
 new text end

new text begin (4) Board of Psychology;
 new text end

new text begin (5) Board or Nursing;
 new text end

new text begin (6) Board of Medical Practice;
 new text end

new text begin (7) Department of Education;
 new text end

new text begin (8) Department of Commerce;
 new text end

new text begin (9) Board of Chiropractic Examiners;
 new text end

new text begin (10) Board of Dentistry;
 new text end

new text begin (11) Board of Marriage and Family Therapy;
 new text end

new text begin (12) Department of Human Services;
 new text end

new text begin (13) Peace Officer Standards and Training (POST) Board; and
 new text end

new text begin (14) Professional Educator Licensing and Standards Board.
 new text end

new text begin (b) The commissioner and each of the agencies listed above, except for the Department
of Human Services, shall enter into a written agreement to provide the commissioner with
electronic access to the relevant licensing data and to provide the commissioner with a
quarterly list of new sanctions issued by the agency.
 new text end

new text begin (c) The commissioner shall provide to the court the electronically available data
maintained in the agency's database, including whether the proposed guardian or conservator
is or has been licensed by the agency, and whether a disciplinary action or a sanction against
the individual's license, including a condition, suspension, revocation, or cancellation is in
the licensing agency's database.
 new text end

new text begin (d) If the proposed guardian or conservator has resided in a state other than Minnesota
during the previous ten years, licensing agency data under this section shall also include
licensing agency data from any other state where the proposed guardian or conservator
reported to have resided during the previous ten years if the study subject has a current or
prior affiliation to the licensing agency. If the proposed guardian or conservator has or has
had a professional license in another state that is directly related to the responsibilities of a
professional fiduciary from one of the agencies listed under paragraph (a), state licensing
agency data shall also include data from the relevant licensing agency of the other state.
 new text end

new text begin (e) The commissioner is not required to repeat a search for Minnesota or out-of-state
licensing data on an individual if the commissioner has provided this information to the
court within the prior five years.
 new text end

new text begin (f) The commissioner shall review the information in paragraph (c) at least once every
four months to determine whether an individual who has been studied within the previous
five years:
 new text end

new text begin (1) has any new disciplinary action or sanction against the individual's license; or
 new text end

new text begin (2) did not disclose a prior or current affiliation with a Minnesota licensing agency.
 new text end

new text begin (g) If the commissioner's review in paragraph (f) identifies new information, the
commissioner shall provide any new information to the court.
 new text end

new text begin Subd. 8. new text end

new text begin Guardians ad litem. new text end

new text begin The commissioner shall conduct an alternative background
study of:
 new text end

new text begin (1) a guardian ad litem appointed under section 518.165 if a background study of the
guardian ad litem has not been completed within the past three years. The background study
of the guardian ad litem must be completed before the court appoints the guardian ad litem,
unless the court determines that it is in the best interests of the child to appoint the guardian
ad litem before a background study is completed by the commissioner.
 new text end

new text begin (2) a guardian ad litem once every three years after the guardian has been appointed, as
long as the individual continues to serve as a guardian ad litem.
 new text end

new text begin Subd. 9. new text end

new text begin Required checks. new text end

new text begin (a) An alternative background study under subdivision 5
must include:
 new text end

new text begin (1) criminal history data from the Bureau of Criminal Apprehension and other criminal
history data held by the commissioner of human services;
 new text end

new text begin (2) data regarding whether the person has been a perpetrator of substantiated maltreatment
of a minor or a vulnerable adult. If the study subject has been determined by the Department
of Human Services or the Department of Health to be the perpetrator of substantiated
maltreatment of a minor or a vulnerable adult in a licensed facility, the response must include
a copy of the public portion of the investigation memorandum under section 260E.30 or the
public portion of the investigation memorandum under section 626.557, subdivision 12b.
When the background study shows that the subject has been determined by a county adult
protection or child protection agency to have been responsible for maltreatment, the court
shall be informed of the county, the date of the finding, and the nature of the maltreatment
that was substantiated;
 new text end

new text begin (3) when the information from the Bureau of Criminal Apprehension indicates that the
study subject is a multistate offender or that the subject's multistate offender status is
undetermined, the court shall require a national criminal history records check, and shall
provide the commissioner with a set of classifiable fingerprints of the study subject.
 new text end

new text begin (b) For checks of records under paragraph (a), clauses (1) and (2), the commissioner
shall provide the investigating information within 15 working days of receiving the request.
The information obtained under sections 245C.05 and 245C.08 from a national criminal
history records check shall be provided within three working days of the commissioner's
receipt of the data.
 new text end

new text begin (c) Notwithstanding section 260E.30 or 626.557, subdivision 12b, if the commissioner
or county lead agency or lead investigative agency has information that a person of whom
a background study was previously completed under this section has been determined to
be a perpetrator of maltreatment of a minor or vulnerable adult, the commissioner or the
county may provide this information to the court that requested the background study.
 new text end

new text begin Subd. 10. new text end

new text begin First-time applicants for educator licenses with the Professional Educator
Licensing and Standards Board. new text end

new text begin The Professional Educator Licensing and Standards
Board shall make all eligibility determinations for alternative background studies conducted
under this section for the Professional Educator Licensing and Standards Board. The
commissioner may conduct an alternative background study of all first-time applicants for
educator licenses pursuant to section 122A.18, subdivision 8. The alternative background
study for all first-time applicants for educator licenses must include a review of information
from the Bureau of Criminal Apprehension, including criminal history data as defined in
section 13.87, and must also include a review of the national criminal records repository.
 new text end

new text begin Subd. 11. new text end

new text begin First-time applicants for administrator licenses with the Board of School
Administrators. new text end

new text begin The Board of School Administrators shall make all eligibility determinations
for alternative background studies conducted under this section for the Board of School
Administrators. The commissioner may conduct an alternative background study of all
first-time applicants for administrator licenses pursuant to section 122A.18, subdivision 8.
The alternative background study for all first-time applicants for administrator licenses must
include a review of information from the Bureau of Criminal Apprehension, including
criminal history data as defined in section 13.87, and must also include a review of the
national criminal records repository.
 new text end

new text begin Subd. 12. new text end

new text begin MNsure. new text end

new text begin The commissioner shall conduct a background study of any individual
required under section 62V.05 to have a background study completed under this chapter.
 new text end

Sec. 9.

Minnesota Statutes 2020, section 245C.05, subdivision 1, is amended to read:


Subdivision 1.

Individual studied.

(a) The individual who is the subject of the
background study must provide the applicant, license holder, or other entity under section
245C.04 with sufficient information to ensure an accurate study, including:

(1) the individual's first, middle, and last name and all other names by which the
individual has been known;

(2) current home address, city, and state of residence;

(3) current zip code;

(4) sex;

(5) date of birth;

(6) driver's license number or state identification number; and

(7) upon implementation of NETStudy 2.0, the home address, city, county, and state of
residence for the past five years.

(b) Every subject of a background study conducted or initiated by counties or deleted text begin private
agenciesdeleted text end new text begin commissioner's delegatesnew text end under this chapter must also provide the home address,
city, county, and state of residence for the past five years.

(c) Every subject of a background study related to private agency adoptions or related
to child foster care licensed through a private agency, who is 18 years of age or older, shall
also provide the commissioner a signed consent for the release of any information received
from national crime information databases to the private agency that initiated the background
study.

(d) The subject of a background study shall provide fingerprints and a photograph as
required in subdivision 5.

new text begin (e) The subject of a background study shall submit a completed criminal and maltreatment
history records check consent form for applicable national and state level record checks.
 new text end

Sec. 10.

Minnesota Statutes 2020, section 245C.05, subdivision 2, is amended to read:


Subd. 2.

Applicant, license holder, or other entity.

(a) The applicant, license holder,
or other deleted text begin entitiesdeleted text end new text begin entity initiating the background studynew text end as provided in this chapter shall verify
that the information collected under subdivision 1 about an individual who is the subject of
the background study is correct and must provide the information on forms or in a format
prescribed by the commissioner.

(b) The information collected under subdivision 1 about an individual who is the subject
of a completed background study may only be viewable by an entity that initiates a
subsequent background study on that individual under NETStudy 2.0 after the entity has
paid the applicable fee for the study and has provided the individual with the privacy notice
in subdivision 2c.

Sec. 11.

Minnesota Statutes 2020, section 245C.05, subdivision 2a, is amended to read:


Subd. 2a.

County or private agency.

For background studies related to child foster care
when the applicant or license holder resides in the home where child foster care services
are provided, county and private agencies new text begin initiating the background study new text end must collect the
information under subdivision 1 and forward it to the commissioner.

Sec. 12.

Minnesota Statutes 2020, section 245C.05, subdivision 2b, is amended to read:


Subd. 2b.

County agency to collect and forward information to commissioner.

(a)
For background studies related to all family adult day services and to adult foster care when
the adult foster care license holder resides in the adult foster care residence, the county
agency new text begin or private agency initiating the background study new text end must collect the information
required under subdivision 1 and forward it to the commissioner.

(b) Upon implementation of NETStudy 2.0, for background studies related to family
child care and legal nonlicensed child care authorized under chapter 119B, the county agency
new text begin initiating the background study new text end must collect the information required under subdivision 1
and provide the information to the commissioner.

Sec. 13.

Minnesota Statutes 2020, section 245C.05, subdivision 4, is amended to read:


Subd. 4.

Electronic transmission.

(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:

(1) background study information to the commissioner;

(2) background study results to the license holder;

(3) background study deleted text begin resultsdeleted text end new text begin information obtained under this section and section 245C.08new text end
to countiesnew text begin and private agenciesnew text end for background studies conducted by the commissioner for
child foster care; and

(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day services and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119B.

(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.

(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.

(d) Section 245C.08, subdivision 3, paragraph (c), applies to results transmitted under
this subdivision.

new text begin (e) Information obtained under this section and section 245C.08 applies to state and
tribal agencies for alternative studies under section 245C.031.
 new text end

Sec. 14.

Minnesota Statutes 2020, section 245C.08, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Authorized recipient. new text end

new text begin The commissioner of human services shall be the
authorized recipient of information and records received under this chapter.
 new text end

Sec. 15.

Minnesota Statutes 2020, section 245C.08, is amended by adding a subdivision
to read:


new text begin Subd. 6. new text end

new text begin Bureau of Criminal Apprehension background check crimes. new text end

new text begin When
applicable, all background studies conducted under this chapter shall comply with the
requirements of sections 299C.60 to 299C.64.
 new text end

Sec. 16.

Minnesota Statutes 2020, section 245C.10, subdivision 15, is amended to read:


Subd. 15.

Guardians and conservators.

The deleted text begin commissioner shall recover the cost of
conducting background studies for guardians and conservators under section 524.5-118
through a fee of no more than $110 per study. The fees collected under this subdivision are
appropriated to the commissioner for the purpose of conducting background studies.deleted text end new text begin fee
for conducting an alternative background study for appointment of a professional guardian
or conservator must be paid by the guardian or conservator. In other cases, the fee must be
paid as follows:
new text end

new text begin (1) if the matter is proceeding in forma pauperis, the fee must be paid as an expense for
purposes of section 524.5-502, paragraph (a);
 new text end

new text begin (2) if there is an estate of the ward or protected person, the fee must be paid from the
estate; or
 new text end

new text begin (3) in the case of a guardianship or conservatorship of a person that is not proceeding
in forma pauperis, the fee must be paid by the guardian, conservator, or the court.
 new text end

Sec. 17.

Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 18. new text end

new text begin Applicants, licensees, and other occupations regulated by commissioner
of health. new text end

new text begin The applicant or license holder is responsible for paying to the Department of
Human Services all fees associated with the preparation of the fingerprints, the criminal
records check consent form, and the criminal background check.
 new text end

Sec. 18.

Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 19. new text end

new text begin Guardians ad litem. new text end

new text begin The Minnesota Supreme Court shall pay the commissioner
a fee for conducting an alternative background study.
 new text end

Sec. 19.

Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 20. new text end

new text begin Occupations regulated by MNsure. new text end

new text begin The commissioner shall set fees to
recover the cost of background studies and criminal background checks initiated by MNsure
under sections 62V.05 and 245C.03. The fee amount shall be established through interagency
agreement between the commissioner and the board of MNsure or its designee. The fees
collected under this subdivision shall be deposited in the special revenue fund and are
appropriated to the commissioner for the purpose of conducting background studies and
criminal background checks.
 new text end

Sec. 20.

Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 21. new text end

new text begin Professional Educators Licensing Standards Board. new text end

new text begin The commissioner
shall recover the cost of background studies initiated by the Professional Educators Licensing
Standards Board through a fee of no more than $51 per study. Fees collected under this
subdivision are appropriated to the commissioner for purposes of conducting background
studies.
 new text end

Sec. 21.

Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 22. new text end

new text begin Board of School Administrators. new text end

new text begin The commissioner shall recover the cost
of background studies initiated by the Board of School Administrators through a fee of no
more than $51 per study. Fees collected under this subdivision are appropriated to the
commissioner for purposes of conducting background studies.
 new text end

Sec. 22.

Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 23. new text end

new text begin Background studies fee schedule. new text end

new text begin (a) By March 1 each year, the commissioner
shall publish a schedule of fees sufficient to administer and conduct background studies
under this chapter. The published schedule of fees shall be effective on July 1 each year.
 new text end

new text begin (b) Fees shall be based on the actual costs of administering and conducting background
studies, including payments to external agencies, department indirect cost payments under
section 16A.127, processing fees, and costs related to due process.
 new text end

new text begin (c) The commissioner shall publish notice of fees by posting fee amounts on the
department website. The notice shall specify the actual costs that comprise the fees, including
the categories described in paragraph (b).
 new text end

new text begin (d) The published schedule of fees shall remain in effect from July 1 to June 30 each
year.
 new text end

new text begin (e) The fees collected under this subdivision are appropriated to the commissioner for
the purpose of conducting background studies.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021. The commissioner of human
services shall publish the initial fee schedule on the Department of Human Services' website
on July 1, 2021, and the initial fee schedule is effective September 1, 2021
 new text end

Sec. 23.

Minnesota Statutes 2020, section 245C.13, subdivision 2, is amended to read:


Subd. 2.

Activities pending completion of background study.

The subject of a
background study may not perform any activity requiring a background study under
paragraph (c) until the commissioner has issued one of the notices under paragraph (a).

(a) Notices from the commissioner required prior to activity under paragraph (c) include:

(1) a notice of the study results under section 245C.17 stating that:

(i) the individual is not disqualified; or

(ii) more time is needed to complete the study but the individual is not required to be
removed from direct contact or access to people receiving services prior to completion of
the study as provided under section 245C.17, subdivision 1, paragraph (b) or (c). The notice
that more time is needed to complete the study must also indicate whether the individual is
required to be under continuous direct supervision prior to completion of the background
study. When more time is necessary to complete a background study of an individual
affiliated with a Title IV-E eligible children's residential facility or foster residence setting,
the individual may not work in the facility or setting regardless of whether or not the
individual is supervised;

(2) a notice that a disqualification has been set aside under section 245C.23; or

(3) a notice that a variance has been granted related to the individual under section
245C.30.

(b) For a background study affiliated with a licensed child care center or certified
license-exempt child care center, the notice sent under paragraph (a), clause (1), item (ii),
must require the individual to be under continuous direct supervision prior to completion
of the background study except as permitted in subdivision 3.

(c) Activities prohibited prior to receipt of notice under paragraph (a) include:

(1) being issued a license;

(2) living in the household where the licensed program will be provided;

(3) providing direct contact services to persons served by a program unless the subject
is under continuous direct supervision;

(4) having access to persons receiving services if the background study was completed
under section 144.057, subdivision 1, or 245C.03, subdivision 1, paragraph (a), clause (2),
(5), or (6), unless the subject is under continuous direct supervision;

new text begin (i) not disqualified under section 245C.14; or
 new text end

new text begin (ii) disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
 new text end

(5) for licensed child care centers and certified license-exempt child care centers,
providing direct contact services to persons served by the program; deleted text begin or
deleted text end

(6) for children's residential facilities or foster residence settings, working in the facility
or settingdeleted text begin .deleted text end new text begin ; or
new text end

new text begin (7) for background studies affiliated with a personal care provider organization, except
as provided in section 245C.03, subdivision 3a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study of
the personal care assistant under this chapter and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
 new text end

new text begin (i) not disqualified under section 245C.14; or
 new text end

new text begin (ii) disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22.
 new text end

Sec. 24.

Minnesota Statutes 2020, section 245C.14, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Disqualification from working in licensed child care centers or certified
license-exempt child care centers. new text end

new text begin (a) For a background study affiliated with a licensed
child care center or certified license-exempt child care center, if an individual is disqualified
from direct contact under subdivision 1, the commissioner must also disqualify the individual
from working in any position regardless of whether the individual would have direct contact
with or access to children served in the licensed child care center or certified license-exempt
child care center and from having access to a person receiving services from the center.
 new text end

new text begin (b) Notwithstanding any other requirement of this chapter, for a background study
affiliated with a licensed child care center or a certified license-exempt child care center, if
an individual is disqualified, the individual may not work in the child care center until the
commissioner has issued a notice stating that:
 new text end

new text begin (1) the individual is not disqualified;
 new text end

new text begin (2) a disqualification has been set aside under section 245C.23; or
 new text end

new text begin (3) a variance has been granted related to the individual under section 245C.30.
 new text end

Sec. 25.

Minnesota Statutes 2020, section 245C.16, subdivision 1, is amended to read:


Subdivision 1.

Determining immediate risk of harm.

(a) If the commissioner determines
that the individual studied has a disqualifying characteristic, the commissioner shall review
the information immediately available and make a determination as to the subject's immediate
risk of harm to persons served by the program where the individual studied will have direct
contact with, or access to, people receiving services.

(b) The commissioner shall consider all relevant information available, including the
following factors in determining the immediate risk of harm:

(1) the recency of the disqualifying characteristic;

(2) the recency of discharge from probation for the crimes;

(3) the number of disqualifying characteristics;

(4) the intrusiveness or violence of the disqualifying characteristic;

(5) the vulnerability of the victim involved in the disqualifying characteristic;

(6) the similarity of the victim to the persons served by the program where the individual
studied will have direct contact;

(7) whether the individual has a disqualification from a previous background study that
has not been set aside; deleted text begin and
deleted text end

(8) if the individual has a disqualification which may not be set aside because it is a
permanent bar under section 245C.24, subdivision 1, or the individual is a child care
background study subject who has a felony-level conviction for a drug-related offense in
the last five years, the commissioner may order the immediate removal of the individual
from any position allowing direct contact with, or access to, persons receiving services from
the program and from working in a children's residential facility or foster residence settingdeleted text begin .deleted text end new text begin ;
and
new text end

new text begin (9) if the individual has a disqualification which may not be set aside because it is a
permanent bar under section 245C.24, subdivision 2, or the individual is a child care
background study subject who has a felony-level conviction for a drug-related offense during
the last five years, the commissioner may order the immediate removal of the individual
from any position allowing direct contact with or access to persons receiving services from
the center and from working in a licensed child care center or certified license-exempt child
care center.
 new text end

(c) This section does not apply when the subject of a background study is regulated by
a health-related licensing board as defined in chapter 214, and the subject is determined to
be responsible for substantiated maltreatment under section 626.557 or chapter 260E.

(d) This section does not apply to a background study related to an initial application
for a child foster family setting license.

(e) Except for paragraph (f), this section does not apply to a background study that is
also subject to the requirements under section 256B.0659, subdivisions 11 and 13, for a
personal care assistant or a qualified professional as defined in section 256B.0659,
subdivision 1.

(f) If the commissioner has reason to believe, based on arrest information or an active
maltreatment investigation, that an individual poses an imminent risk of harm to persons
receiving services, the commissioner may order that the person be continuously supervised
or immediately removed pending the conclusion of the maltreatment investigation or criminal
proceedings.

Sec. 26.

Minnesota Statutes 2020, section 245C.16, subdivision 2, is amended to read:


Subd. 2.

Findings.

(a) After evaluating the information immediately available under
subdivision 1, the commissioner may have reason to believe one of the following:

(1) the individual poses an imminent risk of harm to persons served by the program
where the individual studied will have direct contact or access to persons served by the
program or where the individual studied will work;

(2) the individual poses a risk of harm requiring continuous, direct supervision while
providing direct contact services during the period in which the subject may request a
reconsideration; or

(3) the individual does not pose an imminent risk of harm or a risk of harm requiring
continuous, direct supervision while providing direct contact services during the period in
which the subject may request a reconsideration.

(b) After determining an individual's risk of harm under this section, the commissioner
must notify the subject of the background study and the applicant or license holder as
required under section 245C.17.

(c) For Title IV-E eligible children's residential facilities and foster residence settings,
the commissioner is prohibited from making the findings in paragraph (a), clause (2) or (3).

new text begin (d) For licensed child care centers or certified license-exempt child care centers, the
commissioner is prohibited from making the findings in paragraph (a), clause (2) or (3).
 new text end

Sec. 27.

Minnesota Statutes 2020, section 245C.17, subdivision 1, is amended to read:


Subdivision 1.

Time frame for notice of study results and auditing system access.

(a)
Within three working days after the commissioner's receipt of a request for a background
study submitted through the commissioner's NETStudy or NETStudy 2.0 system, the
commissioner shall notify the background study subject and the license holder or other
entity as provided in this chapter in writing or by electronic transmission of the results of
the study or that more time is needed to complete the study. The notice to the individual
shall include the identity of the entity that initiated the background study.

(b) Before being provided access to NETStudy 2.0, the license holder or other entity
under section 245C.04 shall sign an acknowledgment of responsibilities form developed
by the commissioner that includes identifying the sensitive background study information
person, who must be an employee of the license holder or entity. All queries to NETStudy
2.0 are electronically recorded and subject to audit by the commissioner. The electronic
record shall identify the specific user. A background study subject may request in writing
to the commissioner a report listing the entities that initiated a background study on the
individual.

(c) When the commissioner has completed a prior background study on an individual
that resulted in an order for immediate removal and more time is necessary to complete a
subsequent study, the notice that more time is needed that is issued under paragraph (a)
shall include an order for immediate removal of the individual from any position allowing
direct contact with or access to people receiving services and from working in a children's
residential facility deleted text begin ordeleted text end new text begin ,new text end foster residence settingnew text begin , child care center, or certified license-exempt
child care centernew text end pending completion of the background study.

Sec. 28.

Minnesota Statutes 2020, section 245C.17, is amended by adding a subdivision
to read:


new text begin Subd. 8. new text end

new text begin Disqualification notice to child care centers and certified license-exempt
child care centers. new text end

new text begin (a) For child care centers and certified license-exempt child care centers,
all notices under this section that order the license holder to immediately remove the
individual studied from any position allowing direct contact with, or access to a person
served by the center, must also order the license holder to immediately remove the individual
studied from working in any position regardless of whether the individual would have direct
contact with or access to children served in the center.
 new text end

new text begin (b) For child care centers and certified license-exempt child care centers, notices under
this section must not allow an individual to work in the center.
 new text end

Sec. 29.

Minnesota Statutes 2020, section 245C.18, is amended to read:


245C.18 OBLIGATION TO REMOVE DISQUALIFIED INDIVIDUAL FROM
DIRECT CONTACT AND FROM WORKING IN A PROGRAM, FACILITY, deleted text begin ORdeleted text end
SETTINGnew text begin , OR CENTERnew text end .

(a) Upon receipt of notice from the commissioner, the license holder must remove a
disqualified individual from direct contact with persons served by the licensed program if:

(1) the individual does not request reconsideration under section 245C.21 within the
prescribed time;

(2) the individual submits a timely request for reconsideration, the commissioner does
not set aside the disqualification under section 245C.22, subdivision 4, and the individual
does not submit a timely request for a hearing under sections 245C.27 and 256.045, or
245C.28 and chapter 14; or

(3) the individual submits a timely request for a hearing under sections 245C.27 and
256.045, or 245C.28 and chapter 14, and the commissioner does not set aside or rescind the
disqualification under section 245A.08, subdivision 5, or 256.045.

(b) For children's residential facility and foster residence setting license holders, upon
receipt of notice from the commissioner under paragraph (a), the license holder must also
remove the disqualified individual from working in the program, facility, or setting and
from access to persons served by the licensed program.

(c) For Title IV-E eligible children's residential facility and foster residence setting
license holders, upon receipt of notice from the commissioner under paragraph (a), the
license holder must also remove the disqualified individual from working in the program
and from access to persons served by the program and must not allow the individual to work
in the facility or setting until the commissioner has issued a notice stating that:

(1) the individual is not disqualified;

(2) a disqualification has been set aside under section 245C.23; or

(3) a variance has been granted related to the individual under section 245C.30.

new text begin (d) For licensed child care center and certified license-exempt child care center license
holders, upon receipt of notice from the commissioner under paragraph (a), the license
holder must remove the disqualified individual from working in any position regardless of
whether the individual would have direct contact with or access to children served in the
center and from having access to persons served by the center and must not allow the
individual to work in the center until the commissioner has issued a notice stating that:
 new text end

new text begin (1) the individual is not disqualified;
 new text end

new text begin (2) a disqualification has been set aside under section 245C.23; or
 new text end

new text begin (3) a variance has been granted related to the individual under section 245C.30.
 new text end

Sec. 30. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes shall renumber Minnesota Statutes, section 245C.02, so that the
subdivisions are alphabetical. The revisor shall correct any cross-references that arise as a
result of the renumbering.
 new text end

Sec. 31. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2020, section 245C.10, subdivisions 2, 2a, 3, 4, 5, 6, 7, 8, 9, 9a, 10,
11, 12, 13, 14, and 16, new text end new text begin are repealed.
 new text end

ARTICLE 6

BLUE RIBBON COMMISSION

Section 1.

Minnesota Statutes 2020, section 174.30, subdivision 3, is amended to read:


Subd. 3.

Other standards; wheelchair securement; protected transport.

(a) A special
transportation service that transports individuals occupying wheelchairs is subject to the
provisions of sections 299A.11 to 299A.17 concerning wheelchair securement devices. The
commissioners of transportation and public safety shall cooperate in the enforcement of
this section and sections 299A.11 to 299A.17 so that a single inspection is sufficient to
ascertain compliance with sections 299A.11 to 299A.17 and with the standards adopted
under this section. Representatives of the Department of Transportation may inspect
wheelchair securement devices in vehicles operated by special transportation service
providers to determine compliance with sections 299A.11 to 299A.17 and to issue certificates
under section 299A.14, subdivision 4.

(b) In place of a certificate issued under section 299A.14, the commissioner may issue
a decal under subdivision 4 for a vehicle equipped with a wheelchair securement device if
the device complies with sections 299A.11 to 299A.17 and the decal displays the information
in section 299A.14, subdivision 4.

(c) For vehicles designated as protected transport under section 256B.0625, subdivision
17, paragraph deleted text begin (h)deleted text end new text begin (g)new text end , the commissioner of transportation, during the commissioner's
inspection, shall check to ensure the safety provisions contained in that paragraph are in
working order.

Sec. 2.

Minnesota Statutes 2020, section 256.983, is amended to read:


256.983 FRAUD PREVENTION INVESTIGATIONS.

Subdivision 1.

Programs established.

Within the limits of available appropriations, the
commissioner of human services shall require the maintenance of budget neutral fraud
prevention investigation programs in the counties new text begin or tribal agencies new text end participating in the
fraud prevention investigation project established under this section. If funds are sufficient,
the commissioner may also extend fraud prevention investigation programs to other counties
new text begin or tribal agencies new text end provided the expansion is budget neutral to the state. Under any expansion,
the commissioner has the final authority in decisions regarding the creation and realignment
of individual countynew text begin , tribal agency,new text end or regional operations.

Subd. 2.

County new text begin and tribal agency new text end proposals.

Each participating county new text begin and tribal
new text end agency shall develop and submit an annual staffing and funding proposal to the commissioner
no later than April 30 of each year. Each proposal shall include, but not be limited to, the
staffing and funding of the fraud prevention investigation program, a job description for
investigators involved in the fraud prevention investigation program, and the organizational
structure of the county new text begin or tribal new text end agency unit, training programs for case workers, and the
operational requirements which may be directed by the commissioner. The proposal shall
be approved, to include any changes directed or negotiated by the commissioner, no later
than June 30 of each year.

Subd. 3.

Department responsibilities.

The commissioner shall establish training
programs which shall be attended by all investigative and supervisory staff of the involved
county new text begin and tribal new text end agencies. The commissioner shall also develop the necessary operational
guidelines, forms, and reporting mechanisms, which shall be used by the involved countynew text begin
or tribalnew text end agencies. An individual's application or redetermination form for public assistance
benefits, including child care assistance programs and medical care programs, must include
an authorization for release by the individual to obtain documentation for any information
on that form which is involved in a fraud prevention investigation. The authorization for
release is effective for six months after public assistance benefits have ceased.

Subd. 4.

Funding.

(a) County new text begin and tribal new text end agency reimbursement shall be made through
the settlement provisions applicable to the Supplemental Nutrition Assistance Program
(SNAP), MFIP, child care assistance programs, the medical assistance program, and other
federal and state-funded programs.

(b) The commissioner will maintain program compliance if for any three consecutive
month period, a county new text begin or tribal new text end agency fails to comply with fraud prevention investigation
program guidelines, or fails to meet the cost-effectiveness standards developed by the
commissioner. This result is contingent on the commissioner providing written notice,
including an offer of technical assistance, within 30 days of the end of the third or subsequent
month of noncompliance. The county new text begin or tribal new text end agency shall be required to submit a corrective
action plan to the commissioner within 30 days of receipt of a notice of noncompliance.
Failure to submit a corrective action plan or, continued deviation from standards of more
than ten percent after submission of a corrective action plan, will result in denial of funding
for each subsequent month, or billing the county new text begin or tribal new text end agency for fraud prevention
investigation (FPI) service provided by the commissioner, or reallocation of program grant
funds, or investigative resources, or both, to other countiesnew text begin or tribal agenciesnew text end . The denial of
funding shall apply to the general settlement received by the county new text begin or tribal new text end agency on a
quarterly basis and shall not reduce the grant amount applicable to the FPI project.

Subd. 5.

Child care providers; financial misconduct.

(a) A county or tribal agency
may conduct investigations of financial misconduct by child care providers as described in
chapter 245E. Prior to opening an investigation, a county or tribal agency must contact the
commissioner to determine whether an investigation under this chapter may compromise
an ongoing investigation.

(b) If, upon investigation, a preponderance of evidence shows a provider committed an
intentional program violation, intentionally gave the county or tribe materially false
information on the provider's billing forms, provided false attendance records to a county,
tribe, or the commissioner, or committed financial misconduct as described in section
245E.01, subdivision 8, the county or tribal agency may suspend a provider's payment
pursuant to chapter 245E, or deny or revoke a provider's authorization pursuant to section
119B.13, subdivision 6, paragraph (d), clause (2), prior to pursuing other available remedies.
The countynew text begin or tribenew text end must send notice in accordance with the requirements of section
119B.161, subdivision 2. If a provider's payment is suspended under this section, the payment
suspension shall remain in effect until: (1) the commissioner, county,new text begin tribe,new text end or a law
enforcement authority determines that there is insufficient evidence warranting the action
and a county, tribe, or the commissioner does not pursue an additional administrative remedy
under chapter 119B or 245E, or section 256.046 or 256.98; or (2) all criminal, civil, and
administrative proceedings related to the provider's alleged misconduct conclude and any
appeal rights are exhausted.

(c) For the purposes of this section, an intentional program violation includes intentionally
making false or misleading statements; intentionally misrepresenting, concealing, or
withholding facts; and repeatedly and intentionally violating program regulations under
chapters 119B and 245E.

(d) A provider has the right to administrative review under section 119B.161 if: (1)
payment is suspended under chapter 245E; or (2) the provider's authorization was denied
or revoked under section 119B.13, subdivision 6, paragraph (d), clause (2).

Sec. 3.

new text begin [256B.0371] ADMINISTRATION OF DENTAL SERVICES.
 new text end

new text begin (a) Effective January 1, 2023, the commissioner shall contract with up to two dental
administrators to administer dental services for all recipients of medical assistance and
MinnesotaCare, including the administration of dental services for those enrolled in managed
care under section 256B.69.
 new text end

new text begin (b) The dental administrator must provide administrative services including but not
limited to:
 new text end

new text begin (1) provider recruitment, contracting, and assistance;
 new text end

new text begin (2) recipient outreach and assistance;
 new text end

new text begin (3) utilization management and review for medical necessity of dental services;
 new text end

new text begin (4) dental claims processing;
 new text end

new text begin (5) coordination with other services;
 new text end

new text begin (6) management of fraud and abuse;
 new text end

new text begin (7) monitoring of access to dental services;
 new text end

new text begin (8) performance measurement;
 new text end

new text begin (9) quality improvement and evaluation requirements; and
 new text end

new text begin (10) management of third-party liability requirements.
 new text end

new text begin (c) Payments to contracted dental providers must be at the rates established under section
256B.76.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2020, section 256B.04, subdivision 12, is amended to read:


Subd. 12.

Limitation on services.

deleted text begin (a)deleted text end Place limits on the types of services covered by
medical assistance, the frequency with which the same or similar services may be covered
by medical assistance for an individual recipient, and the amount paid for each covered
service. deleted text begin The state agency shall promulgate rules establishing maximum reimbursement rates
for emergency and nonemergency transportation.
deleted text end

deleted text begin The rules shall provide:
 deleted text end

deleted text begin (1) an opportunity for all recognized transportation providers to be reimbursed for
nonemergency transportation consistent with the maximum rates established by the agency;
and
 deleted text end

deleted text begin (2) reimbursement of public and private nonprofit providers serving the population with
a disability generally at reasonable maximum rates that reflect the cost of providing the
service regardless of the fare that might be charged by the provider for similar services to
individuals other than those receiving medical assistance or medical care under this chapter.
 deleted text end

deleted text begin (b) The commissioner shall encourage providers reimbursed under this chapter to
coordinate their operation with similar services that are operating in the same community.
To the extent practicable, the commissioner shall encourage eligible individuals to utilize
less expensive providers capable of serving their needs.
 deleted text end

deleted text begin (c) For the purpose of this subdivision and section 256B.02, subdivision 8, and effective
on January 1, 1981, "recognized provider of transportation services" means an operator of
special transportation service as defined in section 174.29 that has been issued a current
certificate of compliance with operating standards of the commissioner of transportation
or, if those standards do not apply to the operator, that the agency finds is able to provide
the required transportation in a safe and reliable manner. Until January 1, 1981, "recognized
transportation provider" includes an operator of special transportation service that the agency
finds is able to provide the required transportation in a safe and reliable manner.
 deleted text end

Sec. 5.

Minnesota Statutes 2020, section 256B.04, subdivision 14, is amended to read:


Subd. 14.

Competitive bidding.

(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:

(1) eyeglasses;

(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;

(3) hearing aids and supplies; and

(4) durable medical equipment, including but not limited to:

(i) hospital beds;

(ii) commodes;

(iii) glide-about chairs;

(iv) patient lift apparatus;

(v) wheelchairs and accessories;

(vi) oxygen administration equipment;

(vii) respiratory therapy equipment;

(viii) electronic diagnostic, therapeutic and life-support systems;

(5) nonemergency medical transportation deleted text begin level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursementsdeleted text end ; and

(6) drugs.

(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.

(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C for deleted text begin special transportation services ordeleted text end
incontinence products and related supplies.

Sec. 6.

Minnesota Statutes 2020, section 256B.0625, subdivision 9, is amended to read:


Subd. 9.

Dental services.

(a) Medical assistance covers dental services.new text begin The commissioner
shall contract with a dental administrator for the administration of dental services. The
contract shall include the administration of dental services for those enrolled in managed
care under section 256B.69.
new text end

(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, limited to one per year;

(3) limited exams;

(4) bitewing x-rays, limited to one per year;

(5) periapical x-rays;

(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;

(7) prophylaxis, limited to one per year;

(8) application of fluoride varnish, limited to one per year;

(9) posterior fillings, all at the amalgam rate;

(10) anterior fillings;

(11) endodontics, limited to root canals on the anterior and premolars only;

(12) removable prostheses, each dental arch limited to one every six years;

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;

(14) palliative treatment and sedative fillings for relief of pain; and

(15) full-mouth debridement, limited to one every five years.

(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:

(1) periodontics, limited to periodontal scaling and root planing once every two years;

(2) general anesthesia; and

(3) full-mouth survey once every five years.

(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants are covered once every five years per permanent molar for
children only;

(3) application of fluoride varnish is covered once every six months; and

(4) orthodontia is eligible for coverage for children only.

(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
covers the following services for adults:

(1) house calls or extended care facility calls for on-site delivery of covered services;

(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;

(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and

(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.

(f) The commissioner shall not require prior authorization for the services included in
paragraph (e), clauses (1) to (3)deleted text begin , and shall prohibit managed care and county-based purchasing
plans from requiring prior authorization for the services included in paragraph (e), clauses
(1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12deleted text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 7.

Minnesota Statutes 2020, section 256B.0625, subdivision 17, is amended to read:


Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transit, as defined in section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers.

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.

(d) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(e) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner deleted text begin in consultation with the
Nonemergency Medical Transportation Advisory Committeedeleted text end ;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;new text begin and
new text end

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by modedeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.
 deleted text end

deleted text begin (f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
 deleted text end

deleted text begin (g)deleted text end new text begin (f)new text end The commissioner may use an order by the recipient's attending physician,
advanced practice registered nurse, or a medical or mental health professional to certify that
the recipient requires nonemergency medical transportation services. Nonemergency medical
transportation providers shall perform driver-assisted services for eligible individuals, when
appropriate. Driver-assisted service includes passenger pickup at and return to the individual's
residence or place of business, assistance with admittance of the individual to the medical
facility, and assistance in passenger securement or in securing of wheelchairs, child seats,
or stretchers in the vehicle.

Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the deleted text begin local agencydeleted text end new text begin administratornew text end .

Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

deleted text begin (h)deleted text end new text begin (g) new text end The administrative agency shall use the level of service process established by
the commissioner deleted text begin in consultation with the Nonemergency Medical Transportation Advisory
Committeedeleted text end to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.

deleted text begin (i)deleted text end new text begin (h)new text end The covered modes of transportation are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

deleted text begin (j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.
 deleted text end

deleted text begin (k)deleted text end new text begin (i)new text end The commissioner shall:

(1) deleted text begin in consultation with the Nonemergency Medical Transportation Advisory Committee,deleted text end
verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

deleted text begin (l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
 deleted text end

deleted text begin (m)deleted text end new text begin (j) new text end Payments for nonemergency medical transportation must be paid based on the
client's assessed mode under paragraph deleted text begin (h)deleted text end new text begin (g)new text end , not the type of vehicle used to provide the
service. deleted text begin The medical assistance reimbursement rates for nonemergency medical transportation
services that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:
deleted text end

deleted text begin (1) $0.22 per mile for client reimbursement;
 deleted text end

deleted text begin (2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;
 deleted text end

deleted text begin (3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;
 deleted text end

deleted text begin (4) $13 for the base rate and $1.30 per mile for assisted transport;
 deleted text end

deleted text begin (5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;
 deleted text end

deleted text begin (6) $75 for the base rate and $2.40 per mile for protected transport; and
 deleted text end

deleted text begin (7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.
 deleted text end

deleted text begin (n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:
 deleted text end

deleted text begin (1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and
 deleted text end

deleted text begin (2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).
 deleted text end

deleted text begin (o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.
 deleted text end

deleted text begin (p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.
 deleted text end

deleted text begin (q)deleted text end new text begin (k)new text end The commissioner, when determining reimbursement rates for nonemergency
medical transportation deleted text begin under paragraphs (m) and (n)deleted text end , shall exempt all modes of transportation
listed under paragraph deleted text begin (i)deleted text end new text begin (h)new text end from Minnesota Rules, part 9505.0445, item R, subitem (2).

Sec. 8.

Minnesota Statutes 2020, section 256B.0625, subdivision 17b, is amended to read:


Subd. 17b.

Documentation required.

(a) As a condition for payment, nonemergency
medical transportation providers must document each occurrence of a service provided to
a recipient according to this subdivision. Providers must maintain odometer and other records
sufficient to distinguish individual trips with specific vehicles and drivers. The documentation
may be collected and maintained using electronic systems or software or in paper form but
must be made available and produced upon request. Program funds paid for transportation
that is not documented according to this subdivision shall be recovered by the new text begin nonemergency
medical transportation vendor or new text end department.

(b) A nonemergency medical transportation provider must compile transportation records
that meet the following requirements:

(1) the record must be in English and must be legible according to the standard of a
reasonable person;

(2) the recipient's name must be on each page of the record; and

(3) each entry in the record must document:

(i) the date on which the entry is made;

(ii) the date or dates the service is provided;

(iii) the printed last name, first name, and middle initial of the driver;

(iv) the signature of the driver attesting to the following: "I certify that I have accurately
reported in this record the trip miles I actually drove and the dates and times I actually drove
them. I understand that misreporting the miles driven and hours worked is fraud for which
I could face criminal prosecution or civil proceedings.";

(v) the signature of the recipient or authorized party attesting to the following: "I certify
that I received the reported transportation service.", or the signature of the provider of
medical services certifying that the recipient was delivered to the provider;

(vi) the address, or the description if the address is not available, of both the origin and
destination, and the mileage for the most direct route from the origin to the destination;

(vii) the mode of transportation in which the service is provided;

(viii) the license plate number of the vehicle used to transport the recipient;

(ix) whether the service was ambulatory or nonambulatory;

(x) the time of the pickup and the time of the drop-off with "a.m." and "p.m."
designations;

(xi) the name of the extra attendant when an extra attendant is used to provide special
transportation service; and

(xii) the electronic source documentation used to calculate driving directions and mileage.

Sec. 9.

Minnesota Statutes 2020, section 256B.0625, subdivision 18b, is amended to read:


Subd. 18b.

deleted text begin Broker dispatching prohibitiondeleted text end new text begin Administration of nonemergency medical
transportationnew text end .

deleted text begin Except for establishing level of service process, the commissioner shall
not use a broker or coordinator for any purpose related to nonemergency medical
transportation services under subdivision 18. deleted text end new text begin The commissioner shall contract either statewide
or regionally for the administration of the nonemergency medical transportation program
in compliance with the provisions of this chapter. The contract shall include the
administration of all covered modes under the nonemergency medical transportation benefit
for those enrolled in managed care as described in section 256B.69.
 new text end

Sec. 10.

Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:


Subd. 5.

Base wage index and standard component values.

(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and

(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);

(3) for day services, day support services, and prevocational services, 20 percent of the
median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093);

(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employersdeleted text begin , except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employersdeleted text end ;

(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);

(6) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);

(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);

(8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

(9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);

(10) for in-home family support and individualized home supports with family training
staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30 percent of
the median wage for community social service specialist (SOC code 21-1099); 40 percent
of the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);

(11) for individualized home supports with training services staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);

(12) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);

(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(14) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);

(16) for individualized home support staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);

(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);

(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);

(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and

(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).

(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) general administrative support ratio: 13.25 percent;

(6) program-related expense ratio: 1.3 percent; and

(7) absence and utilization factor ratio: 3.9 percent.

deleted text begin (c) Component values for family foster care are:
 deleted text end

deleted text begin (1) competitive workforce factor: 4.7 percent;
 deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
 deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
 deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
 deleted text end

deleted text begin (5) general administrative support ratio: 3.3 percent;
 deleted text end

deleted text begin (6) program-related expense ratio: 1.3 percent; and
 deleted text end

deleted text begin (7) absence factor: 1.7 percent.
 deleted text end

deleted text begin (d)deleted text end new text begin (c)new text end Component values for day training and habilitation, day support services, and
prevocational services are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan support ratio: 5.6 percent;

(6) client programming and support ratio: ten percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 1.8 percent; and

(9) absence and utilization factor ratio: 9.4 percent.

deleted text begin (e)deleted text end new text begin (d) new text end Component values for adult day services are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan support ratio: 5.6 percent;

(6) client programming and support ratio: 7.4 percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 1.8 percent; and

(9) absence and utilization factor ratio: 9.4 percent.

deleted text begin (f)deleted text end new text begin (e)new text end Component values for unit-based services with programming are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan supports ratio: 15.5 percent;

(6) client programming and supports ratio: 4.7 percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 6.1 percent; and

(9) absence and utilization factor ratio: 3.9 percent.

deleted text begin (g)deleted text end new text begin (f) new text end Component values for unit-based services without programming except respite
are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) program plan support ratio: 7.0 percent;

(6) client programming and support ratio: 2.3 percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 2.9 percent; and

(9) absence and utilization factor ratio: 3.9 percent.

deleted text begin (h)deleted text end new text begin (g) new text end Component values for unit-based services without programming for respite are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) general administrative support ratio: 13.25 percent;

(6) program-related expense ratio: 2.9 percent; and

(7) absence and utilization factor ratio: 3.9 percent.

deleted text begin (i)deleted text end new text begin (h) new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.

deleted text begin (j)deleted text end new text begin (i) new text end Beginning February 1, 2021, and every two years thereafter, the commissioner
shall report to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over health and human services policy and finance an analysis
of the competitive workforce factor. The report must include recommendations to update
the competitive workforce factor using:

(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;

(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and

(3) workforce data as required under subdivision 10a, paragraph (g).

The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.

deleted text begin (k)deleted text end new text begin (j)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the framework components in paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (6); paragraph deleted text begin (e)deleted text end new text begin (d)new text end , clause (6);
paragraph deleted text begin (f)deleted text end new text begin (e)new text end , clause (6); and paragraph deleted text begin (g)deleted text end new text begin (f)new text end , clause (6); subdivision 6, paragraphs
(b), clauses (9) and (10), and (e), clause (10); and subdivision 7, clauses (11), (17), and
(18)deleted text begin ,deleted text end new text begin ; and subdivision 18,new text end for changes in the Consumer Price Index. The commissioner shall
adjust these values higher or lower by the percentage change in the CPI-U from the date of
the previous update to the data available 30 months and one day prior to the scheduled
update. The commissioner shall publish these updated values and load them into the rate
management system.

deleted text begin (l)deleted text end new text begin (k)new text end Upon the implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin (h)new text end and deleted text begin (k)deleted text end new text begin (j)new text end , rate
adjustments authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108,
article 7, section 60; and Laws 2014, chapter 312, article 27, section 75, shall be removed
from service rates calculated under this section.

deleted text begin (m)deleted text end new text begin (l)new text end Any rate adjustments applied to the service rates calculated under this section
outside of the cost components and rate methodology specified in this section shall be
removed from rate calculations upon implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin
(h)new text end and deleted text begin (k)deleted text end new text begin (j)new text end .

deleted text begin (n)deleted text end new text begin (m)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later.
 new text end

Sec. 11.

Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to read:


Subd. 6.

Payments for residential support services.

(a) For purposes of this subdivision,
residential support services includes 24-hour customized living services, community
residential services, customized living services, deleted text begin family residential services, foster care
services,deleted text end new text begin andnew text end integrated community supportsdeleted text begin , and supportive living services dailydeleted text end .

(b) Payments for community residential servicesdeleted text begin , corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care servicesdeleted text end
must be calculated as follows:

(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages;

(6) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(7) combine the results of clauses (5) and (6), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (3). This is defined as the direct staffing cost;

(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4);

(9) for client programming and supports, the commissioner shall add $2,179; and

(10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

(c) The total rate must be calculated using the following steps:

(1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (8);

(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(d) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.new text begin Customized living and 24-hour customized living rates determined under
this section shall not include more than 24 hours of support in a daily unit.
new text end

(e) Payments for integrated community support services must be calculated as follows:

(1) the base shared staffing shall be eight hours divided by the number of people receiving
support in the integrated community support setting;

(2) the individual staffing hours shall be the average number of direct support hours
provided directly to the service recipient;

(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;

(4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (3) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);

(5) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (4);

(6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;

(7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause
(21);

(8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;

(9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and

(10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.

(f) The total rate must be calculated as follows:

(1) add the results of paragraph (e), clauses (9) and (10);

(2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(g) The payment methodology for customized living and 24-hour customized living
services must be the customized living tool. The commissioner shall revise the customized
living tool to reflect the services and activities unique to disability-related recipient needs
and adjust for regional differences in the cost of providing services.

(h) The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later.
 new text end

Sec. 12.

Minnesota Statutes 2020, section 256B.4914, is amended by adding a subdivision
to read:


new text begin Subd. 18. new text end

new text begin Payments for family residential services. new text end

new text begin The commissioner shall establish
rates for family residential services based on a person's assessed needs as described in the
federally approved waiver plans.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later.
 new text end

Sec. 13.

Minnesota Statutes 2020, section 256B.69, subdivision 6d, is amended to read:


Subd. 6d.

Prescription drugs.

The commissioner deleted text begin maydeleted text end new text begin shallnew text end exclude deleted text begin or modifydeleted text end coverage
for new text begin outpatient new text end prescription drugs new text begin dispensed by a pharmacy to a member eligible for medical
assistance under this chapter new text end from the prepaid managed care contracts entered into under
this section deleted text begin in order to increase savings to the state by collecting additional prescription
drug rebates. The contracts must maintain incentives for the managed care plan to manage
drug costs and utilization and may require that the managed care plans maintain an open
drug formulary. In order to manage drug costs and utilization, the contracts may authorize
the managed care plans to use preferred drug lists and prior authorization. This subdivision
is contingent on federal approval of the managed care contract changes and the collection
of additional prescription drug rebatesdeleted text end .new text begin The commissioner may include, exclude, or modify
coverage for outpatient prescription drugs dispensed by a pharmacy to a member eligible
for MinnesotaCare under chapter 256L and prescription drugs administered to a medical
assistance member or MinnesotaCare member from the prepaid managed care contracts
entered into under this section.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 14.

Minnesota Statutes 2020, section 256B.76, subdivision 2, is amended to read:


Subd. 2.

Dental reimbursement.

(a) Effective for services rendered on or after October
1, 1992, the commissioner shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent
above the rate in effect on June 30, 1992; and

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile
of 1989, less the percent in aggregate necessary to equal the above increases.

(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.

(c) Effective for services rendered on or after January 1, 2000, payment rates for dental
services shall be increased by three percent over the rates in effect on December 31, 1999.

(d) Effective for services provided on or after January 1, 2002, payment for diagnostic
examinations and dental x-rays provided to children under age 21 shall be the lower of (1)
the submitted charge, or (2) 85 percent of median 1999 charges.

(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 2000,
for managed care.

(f) Effective for dental services rendered on or after October 1, 2010, by a state-operated
dental clinic, payment shall be paid on a reasonable cost basis that is based on the Medicare
principles of reimbursement. This payment shall be effective for services rendered on or
after January 1, 2011, to recipients enrolled in managed care plans or county-based
purchasing plans.

(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics in
paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal year, a
supplemental state payment equal to the difference between the total payments in paragraph
(f) and $1,850,000 shall be paid from the general fund to state-operated services for the
operation of the dental clinics.

(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).

(i) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for dental services shall be reduced by three percent. This reduction does not
apply to state-operated dental clinics in paragraph (f).

(j) Effective for services rendered on or after January 1, 2014, payment rates for dental
services shall be increased by five percent from the rates in effect on December 31, 2013.
This increase does not apply to state-operated dental clinics in paragraph (f), federally
qualified health centers, rural health centers, and Indian health services. Effective January
1, 2014, payments made to managed care plans and county-based purchasing plans under
sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase described in
this paragraph.

(k) Effective for services rendered on or after July 1, 2015, through December 31, 2016,
the commissioner shall increase payment rates for services furnished by dental providers
located outside of the seven-county metropolitan area by the maximum percentage possible
above the rates in effect on June 30, 2015, while remaining within the limits of funding
appropriated for this purpose. This increase does not apply to state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health centers, and Indian health
services. Effective January 1, 2016, through December 31, 2016, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph. The commissioner shall require managed
care and county-based purchasing plans to pass on the full amount of the increase, in the
form of higher payment rates to dental providers located outside of the seven-county
metropolitan area.

(l) Effective for services provided on or after January 1, 2017,new text begin through December 31,
2022,new text end the commissioner shall increase payment rates by 9.65 percent for dental services
provided outside of the seven-county metropolitan area. This increase does not apply to
state-operated dental clinics in paragraph (f), federally qualified health centers, rural health
centers, or Indian health services. Effective January 1, 2017, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph.

(m) Effective for services provided on or after July 1, 2017,new text begin through December 31, 2022,new text end
the commissioner shall increase payment rates by 23.8 percent for dental services provided
to enrollees under the age of 21. This rate increase does not apply to state-operated dental
clinics in paragraph (f), federally qualified health centers, rural health centers, or Indian
health centers. This rate increase does not apply to managed care plans and county-based
purchasing plans.

new text begin (n) Effective for dental services provided on or after January 1, 2023, the commissioner
shall increase payment rates by 54 percent. This rate increase must not apply to state-operated
dental clinics in paragraph (f), federally qualified health centers, rural health centers, or
Indian health centers.
 new text end

Sec. 15.

Minnesota Statutes 2020, section 256B.76, subdivision 4, is amended to read:


Subd. 4.

Critical access dental providers.

(a) The commissioner shall increase
reimbursements to dentists and dental clinics deemed by the commissioner to be critical
access dental providers. For dental services rendered on or after July 1, 2016, new text begin through
December 31, 2022, new text end the commissioner shall increase reimbursement by 37.5 percent above
the reimbursement rate that would otherwise be paid to the critical access dental provider,
except as specified under paragraph (b). The commissioner shall pay the managed care
plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.

(b) For dental services rendered on or after July 1, 2016, new text begin through December 31, 2022,
new text end by a dental clinic or dental group that meets the critical access dental provider designation
under paragraph (d), clause (4), and is owned and operated by a health maintenance
organization licensed under chapter 62D, the commissioner shall increase reimbursement
by 35 percent above the reimbursement rate that would otherwise be paid to the critical
access provider.

(c) Critical access dental payments made under paragraph (a) or (b) for dental services
provided by a critical access dental provider to an enrollee of a managed care plan or
county-based purchasing plan must not reflect any capitated payments or cost-based payments
from the managed care plan or county-based purchasing plan. The managed care plan or
county-based purchasing plan must base the additional critical access dental payment on
the amount that would have been paid for that service had the dental provider been paid
according to the managed care plan or county-based purchasing plan's fee schedule that
applies to dental providers that are not paid under a capitated payment or cost-based payment.

(d) The commissioner shall designate the following dentists and dental clinics as critical
access dental providers:

(1) nonprofit community clinics that:

(i) have nonprofit status in accordance with chapter 317A;

(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);

(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;

(iv) have professional staff familiar with the cultural background of the clinic's patients;

(v) charge for services on a sliding fee scale designed to provide assistance to low-income
patients based on current poverty income guidelines and family size;

(vi) do not restrict access or services because of a patient's financial limitations or public
assistance status; and

(vii) have free care available as needed;

(2) federally qualified health centers, rural health clinics, and public health clinics;

(3) hospital-based dental clinics owned and operated by a city, county, or former state
hospital as defined in section 62Q.19, subdivision 1, paragraph (a), clause (4);

(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance or MinnesotaCare;

(5) a dental clinic owned and operated by the University of Minnesota or the Minnesota
State Colleges and Universities system; and

(6) private practicing dentists if:

(i) the dentist's office is located within the seven-county metropolitan area and more
than 50 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare; or

(ii) the dentist's office is located outside the seven-county metropolitan area and more
than 25 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare.

Sec. 16.

Minnesota Statutes 2020, section 256B.766, is amended to read:


256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

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

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

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

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

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

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

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

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

(i) Effective for services provided on or after July 1, 2015,new text begin through June 30, 2021,new text end the
following categories of medical supplies and durable medical equipment shall be individually
priced items: enteral nutrition and supplies, customized and other specialized tracheostomy
tubes and supplies, electric patient lifts, and durable medical equipment repair and service.
This paragraph does not apply to medical supplies and durable medical equipment subject
to a volume purchase contract, products subject to the preferred diabetic testing supply
program, and items provided to dually eligible recipients when Medicare is the primary
payer for the item. The commissioner shall not apply any medical assistance rate reductions
to durable medical equipment as a result of Medicare competitive biddingnew text begin through June 30,
2021new text end .

(j) Effective for services provided on or after July 1, 2015,new text begin through June 30, 2021,new text end
medical assistance payment rates for durable medical equipment, prosthetics, orthotics, or
supplies shall be increased as follows:

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

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

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

(k) Effective for nonpressure support ventilators provided on or after January 1, 2016,new text begin
through June 30, 2021,new text end the rate shall be the lower of the submitted charge or the Medicare
fee schedule rate. Effective for pressure support ventilators provided on or after January 1,
2016,new text begin through June 30, 2021,new text end the rate shall be the lower of the submitted charge or 47 percent
above the Medicare fee schedule rate. For payments made in accordance with this paragraph,
if, and to the extent that, the commissioner identifies that the state has received federal
financial participation for ventilators in excess of the amount allowed effective January 1,
2018, under United States Code, title 42, section 1396b(i)(27), the state shall repay the
excess amount to the Centers for Medicare and Medicaid Services with state funds and
maintain the full payment rate under this paragraph.

(l) Payment rates for durable medical equipment, prosthetics, orthotics or supplies, that
are subject to the upper payment limit in accordance with section 1903(i)(27) of the Social
Security Act, shall be paid the Medicare rate. Rate increases provided in this chapter shall
not be applied to the items listed in this paragraph.

new text begin (m) Effective July 1, 2021, the payment rates for all durable medical equipment,
prosthetics, orthotics, or supplies shall be the lesser of the provider's submitted charges or
the Medicare fee schedule amount, with no increases or decreases described in paragraphs
(a) to (k) applied.
 new text end

new text begin (n) Effective July 1, 2021, the payment rates for durable medical equipment, prosthetics,
orthotics, or supplies for which Medicare has not established a payment amount shall be
the lesser of the provider's submitted charges, or the alternative payment methodology rate
described in clauses (1) to (4) with no increases or decreases described in paragraphs (a) to
(k) applied.
 new text end

new text begin (1) The alternate payment methodology rate is calculated from either:
 new text end

new text begin (i) at least 100 paid claim lines, as priced under paragraph (o), submitted by at least ten
different providers within one calendar month; or
 new text end

new text begin (ii) at least 20 paid claim lines, as priced under paragraph (o), submitted by at least five
different providers within two consecutive quarters for services that are not paid 100 times
in a calendar month.
 new text end

new text begin (2) The alternate payment methodology rate is the mean of the payment per unit of the
claim lines, with the top and bottom ten percent of claim lines, by payment per unit, excluded
from the calculation of the mean.
 new text end

new text begin (3) The alternate payment methodology rate for the rate period will be added to the fee
schedule on the first day of a calendar month or the first day of a calendar quarter if claims
from more than one month were used to determine the rate. The alternate payment
methodology rates will be subject to Medicare's inflation or deflation factor on January 1
of each year unless the rate was calculated and posted to the fee schedule after July 1 of the
previous year.
 new text end

new text begin (4) Not more than once every three years, the alternate payment methodology rates must
be evaluated by the commissioner for reasonableness by reviewing invoices from at least
20 paid claim lines and five different providers for claims paid during one calendar month
or one quarter if necessary to obtain the required sample. If the evaluation identifies that
the alternate payment methodology rate is more than five percent higher or lower than the
provider's actual acquisition cost plus 20 percent, then the commissioner shall recalculate
and update the fee schedule according to clauses (1) to (3). If the evaluation does not show
that the alternate payment methodology fee schedule rate is five percent higher or lower
than the provider's actual acquisition cost plus 20 percent or a sufficient sample cannot be
collected due to low utilization as defined in clause (1), then the commissioner shall maintain
the previously calculated alternate payment methodology rate on the fee schedule.
 new text end

new text begin (o) Until sufficient data is available to calculate the alternative payment methodology,
the payment shall be based on the provider's actual acquisition cost plus 20 percent as
documented on an invoice submitted by the provider. The payment may be based on a quote
the provider received from a vendor showing the provider's actual acquisition cost only if
the durable medical equipment, prosthetic, orthotic, or supply requires authorization and
the rate is required to complete the authorization.
 new text end

new text begin (p) Notwithstanding paragraph (n), durable medical equipment and supplies billed using
miscellaneous codes, and for which no Medicare rate is available, shall be paid the provider's
actual acquisition cost plus ten percent.
 new text end

Sec. 17.

Minnesota Statutes 2020, section 256B.767, is amended to read:


256B.767 MEDICARE PAYMENT LIMIT.

(a) Effective for services rendered on or after July 1, 2010, fee-for-service payment rates
for physician and professional services under section 256B.76, subdivision 1, and basic care
services subject to the rate reduction specified in section 256B.766, shall not exceed the
Medicare payment rate for the applicable service, as adjusted for any changes in Medicare
payment rates after July 1, 2010. The commissioner shall implement this section after any
other rate adjustment that is effective July 1, 2010, and shall reduce rates under this section
by first reducing or eliminating provider rate add-ons.

(b) This section does not apply to services provided by advanced practice certified nurse
midwives licensed under chapter 148 or traditional midwives licensed under chapter 147D.
Notwithstanding this exemption, medical assistance fee-for-service payment rates for
advanced practice certified nurse midwives and licensed traditional midwives shall equal
and shall not exceed the medical assistance payment rate to physicians for the applicable
service.

(c) This section does not apply to mental health services or physician services billed by
a psychiatrist or an advanced practice registered nurse with a specialty in mental health.

deleted text begin (d) Effective July 1, 2015, this section shall not apply to durable medical equipment,
prosthetics, orthotics, or supplies.
 deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end This section does not apply to physical therapy, occupational therapy, speech
pathology and related services, and basic care services provided by a hospital meeting the
criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4).

Sec. 18.

Minnesota Statutes 2020, section 256L.11, subdivision 7, is amended to read:


Subd. 7.

Critical access dental providers.

Effective for dental services provided to
MinnesotaCare enrollees on or after July 1, 2017, new text begin through December 31, 2022, new text end the
commissioner shall increase payment rates to dentists and dental clinics deemed by the
commissioner to be critical access providers under section 256B.76, subdivision 4, by 20
percent above the payment rate that would otherwise be paid to the provider. The
commissioner shall pay the prepaid health plans under contract with the commissioner
amounts sufficient to reflect this rate increase. The prepaid health plan must pass this rate
increase to providers who have been identified by the commissioner as critical access dental
providers under section 256B.76, subdivision 4.

Sec. 19. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2020, sections 256B.0625, subdivisions 18c, 18d, 18e, and 18h; and
256L.11, subdivision 6a, new text end new text begin are repealed.
 new text end

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 7

MENTAL HEALTH UNIFORM SERVICE STANDARDS: CORE

Section 1.

new text begin [245I.01] PURPOSE AND CITATION.
 new text end

new text begin Subdivision 1. new text end

new text begin Citation. new text end

new text begin This chapter may be cited as the "Mental Health Uniform
Service Standards Act."
 new text end

new text begin Subd. 2. new text end

new text begin Purpose. new text end

new text begin In accordance with sections 245.461 and 245.487, the purpose of this
chapter is to create a system of mental health care that is unified, accountable, and
comprehensive, and to promote the recovery and resiliency of Minnesotans who have mental
illnesses. The state's public policy is to support Minnesotans' access to quality outpatient
and residential mental health services. Further, the state's public policy is to protect the
health and safety, rights, and well-being of Minnesotans receiving mental health services.
 new text end

Sec. 2.

new text begin [245I.011] APPLICABILITY.
 new text end

new text begin Subdivision 1. new text end

new text begin License requirements. new text end

new text begin A license holder under this chapter must comply
with the requirements in chapters 245A, 245C, and 260E; section 626.557; and Minnesota
Rules, chapter 9544.
 new text end

new text begin Subd. 2. new text end

new text begin Variances. new text end

new text begin (a) The commissioner may grant a variance to an applicant, license
holder, or certification holder as long as the variance does not affect the health or safety of
any person in a licensed or certified program and the applicant, license holder, or certification
holder meets the following conditions:
 new text end

new text begin (1) an applicant, license holder, or certification holder must request the variance on a
form approved by the commissioner and in a manner prescribed by the commissioner;
 new text end

new text begin (2) the request for a variance must include the:
 new text end

new text begin (i) reasons that the applicant, license holder, or certification holder cannot comply with
a requirement as stated in the law; and
 new text end

new text begin (ii) alternative equivalent measures that the applicant, license holder, or certification
holder will follow to comply with the intent of the law; and
 new text end

new text begin (3) the request for a variance must state the period of time when the variance is requested.
 new text end

new text begin (b) The commissioner may grant a permanent variance when the conditions under which
the applicant, license holder, or certification holder requested the variance do not affect the
health or safety of any person whom the licensed or certified program serves, and when the
conditions of the variance do not compromise the qualifications of staff who provide services
to clients. A permanent variance expires when the conditions that warranted the variance
change in any way. Any applicant, license holder, or certification holder must inform the
commissioner of any changes to the conditions that warranted the permanent variance. If
an applicant, license holder, or certification holder fails to advise the commissioner of
changes to the conditions that warranted the variance, the commissioner must revoke the
permanent variance and may impose other sanctions under sections 245A.06 and 245A.07.
 new text end

new text begin (c) The commissioner's decision to grant or deny a variance request is final and not
subject to appeal under the provisions of chapter 14.
 new text end

new text begin Subd. 3. new text end

new text begin Certification required. new text end

new text begin (a) An individual, organization, or government entity
that is exempt from licensure under section 245A.03, subdivision 2, paragraph (a), clause
(19), and chooses to be identified as a certified mental health clinic must:
 new text end

new text begin (1) be a mental health clinic that is certified under section 245I.20;
 new text end

new text begin (2) comply with all of the responsibilities assigned to a license holder by this chapter
except subdivision 1; and
 new text end

new text begin (3) comply with all of the responsibilities assigned to a certification holder by chapter
245A.
 new text end

new text begin (b) An individual, organization, or government entity described by this subdivision must
obtain a criminal background study for each staff person or volunteer who provides direct
contact services to clients.
 new text end

new text begin Subd. 4. new text end

new text begin License required. new text end

new text begin An individual, organization, or government entity providing
intensive residential treatment services or residential crisis stabilization to adults must be
licensed under section 245I.23.
 new text end

new text begin Subd. 5. new text end

new text begin Programs certified under chapter 256B. new text end

new text begin (a) An individual, organization, or
government entity certified under the following sections must comply with all of the
responsibilities assigned to a license holder under this chapter except subdivision 1:
 new text end

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

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

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

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

new text begin (5) an intensive treatment in foster care provider under section 256B.0946; and
 new text end

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

new text begin (b) An individual, organization, or government entity certified under the sections listed
in paragraph (a), clauses (1) to (6), must obtain a criminal background study for each staff
person and volunteer providing direct contact services to a client.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval or July 1, 2022,
whichever is later.
 new text end

Sec. 3.

new text begin [245I.02] DEFINITIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin For purposes of this chapter, the terms in this section have the
meanings given.
 new text end

new text begin Subd. 2. new text end

new text begin Approval. new text end

new text begin "Approval" means the documented review of, opportunity to request
changes to, and agreement with a treatment document. An individual may demonstrate
approval with a written signature, secure electronic signature, or documented oral approval.
 new text end

new text begin Subd. 3. new text end

new text begin Behavioral sciences or related fields. new text end

new text begin "Behavioral sciences or related fields"
means an education from an accredited college or university in social work, psychology,
sociology, community counseling, family social science, child development, child
psychology, community mental health, addiction counseling, counseling and guidance,
special education, nursing, and other similar fields approved by the commissioner.
 new text end

new text begin Subd. 4. new text end

new text begin Business day. new text end

new text begin "Business day" means a weekday on which government offices
are open for business. Business day does not include state or federal holidays, Saturdays,
or Sundays.
 new text end

new text begin Subd. 5. new text end

new text begin Case manager. new text end

new text begin "Case manager" means a client's case manager according to
section 256B.0596; 256B.0621; 256B.0625, subdivision 20; 256B.092, subdivision 1a;
256B.0924; 256B.093, subdivision 3a; 256B.094; or 256B.49.
 new text end

new text begin Subd. 6. new text end

new text begin Certified rehabilitation specialist. new text end

new text begin "Certified rehabilitation specialist" means
a staff person who meets the qualifications of section 245I.04, subdivision 8.
 new text end

new text begin Subd. 7. new text end

new text begin Child. new text end

new text begin "Child" means a client under the age of 18.
 new text end

new text begin Subd. 8. new text end

new text begin Client. new text end

new text begin "Client" means a person who is seeking or receiving services regulated
by this chapter. For the purpose of a client's consent to services, client includes a parent,
guardian, or other individual legally authorized to consent on behalf of a client to services.
 new text end

new text begin Subd. 9. new text end

new text begin Clinical trainee. new text end

new text begin "Clinical trainee" means a staff person who is qualified
according to section 245I.04, subdivision 6.
 new text end

new text begin Subd. 10. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of human services
or the commissioner's designee.
 new text end

new text begin Subd. 11. new text end

new text begin Co-occurring substance use disorder treatment. new text end

new text begin "Co-occurring substance
use disorder treatment" means the treatment of a person who has a co-occurring mental
illness and substance use disorder. Co-occurring substance use disorder treatment is
characterized by stage-wise comprehensive treatment, treatment goal setting, and flexibility
for clients at each stage of treatment. Co-occurring substance use disorder treatment includes
assessing and tracking each client's stage of change readiness and treatment using a treatment
approach based on a client's stage of change, such as motivational interviewing when working
with a client at an earlier stage of change readiness and a cognitive behavioral approach
and relapse prevention to work with a client at a later stage of change; and facilitating a
client's access to community supports.
 new text end

new text begin Subd. 12. new text end

new text begin Crisis plan. new text end

new text begin "Crisis plan" means a plan to prevent and de-escalate a client's
future crisis situation, with the goal of preventing future crises for the client and the client's
family and other natural supports. Crisis plan includes a crisis plan developed according to
section 245.4871, subdivision 9a.
 new text end

new text begin Subd. 13. new text end

new text begin Critical incident. new text end

new text begin "Critical incident" means an occurrence involving a client
that requires a license holder to respond in a manner that is not part of the license holder's
ordinary daily routine. Critical incident includes a client's suicide, attempted suicide, or
homicide; a client's death; an injury to a client or other person that is life-threatening or
requires medical treatment; a fire that requires a fire department's response; alleged
maltreatment of a client; an assault of a client; an assault by a client; or other situation that
requires a response by law enforcement, the fire department, an ambulance, or another
emergency response provider.
 new text end

new text begin Subd. 14. new text end

new text begin Diagnostic assessment. new text end

new text begin "Diagnostic assessment" means the evaluation and
report of a client's potential diagnoses that a mental health professional or clinical trainee
completes under section 245I.10, subdivisions 4 to 6.
 new text end

new text begin Subd. 15. new text end

new text begin Direct contact. new text end

new text begin "Direct contact" has the meaning given in section 245C.02,
subdivision 11.
 new text end

new text begin Subd. 16. new text end

new text begin Family and other natural supports. new text end

new text begin "Family and other natural supports"
means the people whom a client identifies as having a high degree of importance to the
client. Family and other natural supports also means people that the client identifies as being
important to the client's mental health treatment, regardless of whether the person is related
to the client or lives in the same household as the client.
 new text end

new text begin Subd. 17. new text end

new text begin Functional assessment. new text end

new text begin "Functional assessment" means the assessment of a
client's current level of functioning relative to functioning that is appropriate for someone
the client's age. For a client five years of age or younger, a functional assessment is the
Early Childhood Service Intensity Instrument (ESCII). For a client six to 17 years of age,
a functional assessment is the Child and Adolescent Service Intensity Instrument (CASII).
For a client 18 years of age or older, a functional assessment is the functional assessment
described in section 245I.10, subdivision 9.
 new text end

new text begin Subd. 18. new text end

new text begin Individual abuse prevention plan. new text end

new text begin "Individual abuse prevention plan" means
a plan according to section 245A.65, subdivision 2, paragraph (b), and section 626.557,
subdivision 14.
 new text end

new text begin Subd. 19. new text end

new text begin Level of care assessment. new text end

new text begin "Level of care assessment" means the level of care
decision support tool appropriate to the client's age. For a client five years of age or younger,
a level of care assessment is the Early Childhood Service Intensity Instrument (ESCII). For
a client six to 17 years of age, a level of care assessment is the Child and Adolescent Service
Intensity Instrument (CASII). For a client 18 years of age or older, a level of care assessment
is the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS).
 new text end

new text begin Subd. 20. new text end

new text begin License. new text end

new text begin "License" has the meaning given in section 245A.02, subdivision 8.
 new text end

new text begin Subd. 21. new text end

new text begin License holder. new text end

new text begin "License holder" has the meaning given in section 245A.02,
subdivision 9.
 new text end

new text begin Subd. 22. new text end

new text begin Licensed prescriber. new text end

new text begin "Licensed prescriber" means an individual who is
authorized to prescribe legend drugs under section 151.37.
 new text end

new text begin Subd. 23. new text end

new text begin Mental health behavioral aide. new text end

new text begin "Mental health behavioral aide" means a
staff person who is qualified under section 245I.04, subdivision 16.
 new text end

new text begin Subd. 24. new text end

new text begin Mental health certified family peer specialist. new text end

new text begin "Mental health certified
family peer specialist" means a staff person who is qualified under section 245I.04,
subdivision 12.
 new text end

new text begin Subd. 25. new text end

new text begin Mental health certified peer specialist. new text end

new text begin "Mental health certified peer
specialist" means a staff person who is qualified under section 245I.04, subdivision 10.
 new text end

new text begin Subd. 26. new text end

new text begin Mental health practitioner. new text end

new text begin "Mental health practitioner" means a staff person
who is qualified under section 245I.04, subdivision 4.
 new text end

new text begin Subd. 27. new text end

new text begin Mental health professional. new text end

new text begin "Mental health professional" means a staff person
who is qualified under section 245I.04, subdivision 2.
 new text end

new text begin Subd. 28. new text end

new text begin Mental health rehabilitation worker. new text end

new text begin "Mental health rehabilitation worker"
means a staff person who is qualified under section 245I.04, subdivision 14.
 new text end

new text begin Subd. 29. new text end

new text begin Mental illness. new text end

new text begin "Mental illness" means any of the conditions included in the
most recent editions of the DC: 0-5 Diagnostic Classification of Mental Health and
Development Disorders of Infancy and Early Childhood published by Zero to Three or the
Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric
Association.
 new text end

new text begin Subd. 30. new text end

new text begin Organization. new text end

new text begin "Organization" has the meaning given in section 245A.02,
subdivision 10c.
 new text end

new text begin Subd. 31. new text end

new text begin Personnel file. new text end

new text begin "Personnel file" means a set of records under section 245I.07,
paragraph (a). Personnel files excludes information related to a person's employment that
is not included in section 245I.07.
 new text end

new text begin Subd. 32. new text end

new text begin Registered nurse. new text end

new text begin "Registered nurse" means a staff person who is qualified
under section 148.171, subdivision 20.
 new text end

new text begin Subd. 33. new text end

new text begin Rehabilitative mental health services. new text end

new text begin "Rehabilitative mental health services"
means mental health services provided to an adult client that enable the client to develop
and achieve psychiatric stability, social competencies, personal and emotional adjustment,
independent living skills, family roles, and community skills when symptoms of mental
illness has impaired any of the client's abilities in these areas.
 new text end

new text begin Subd. 34. new text end

new text begin Residential program. new text end

new text begin "Residential program" has the meaning given in section
245A.02, subdivision 14.
 new text end

new text begin Subd. 35. new text end

new text begin Signature. new text end

new text begin "Signature" means a written signature or an electronic signature
defined in section 325L.02, paragraph (h).
 new text end

new text begin Subd. 36. new text end

new text begin Staff person. new text end

new text begin "Staff person" means an individual who works under a license
holder's direction or under a contract with a license holder. Staff person includes an intern,
consultant, contractor, individual who works part-time, and an individual who does not
provide direct contact services to clients. Staff person includes a volunteer who provides
treatment services to a client or a volunteer whom the license holder regards as a staff person
for the purpose of meeting staffing or service delivery requirements. A staff person must
be 18 years of age or older.
 new text end

new text begin Subd. 37. new text end

new text begin Strengths. new text end

new text begin "Strengths" means a person's inner characteristics, virtues, external
relationships, activities, and connections to resources that contribute to a client's resilience
and core competencies. A person can build on strengths to support recovery.
 new text end

new text begin Subd. 38. new text end

new text begin Trauma. new text end

new text begin "Trauma" means an event, series of events, or set of circumstances
that is experienced by an individual as physically or emotionally harmful or life-threatening
that has lasting adverse effects on the individual's functioning and mental, physical, social,
emotional, or spiritual well-being. Trauma includes group traumatic experiences. Group
traumatic experiences are emotional or psychological harm that a group experiences. Group
traumatic experiences can be transmitted across generations within a community and are
often associated with racial and ethnic population groups who suffer major intergenerational
losses.
 new text end

new text begin Subd. 39. new text end

new text begin Treatment plan. new text end

new text begin "Treatment plan" means services that a license holder
formulates to respond to a client's needs and goals. A treatment plan includes individual
treatment plans under section 245I.10, subdivisions 7 and 8; initial treatment plans under
section 245I.23, subdivision 7; and crisis treatment plans under sections 245I.23, subdivision
8, and 256B.0624, subdivision 11.
 new text end

new text begin Subd. 40. new text end

new text begin Treatment supervision. new text end

new text begin "Treatment supervision" means a mental health
professional's or certified rehabilitation specialist's oversight, direction, and evaluation of
a staff person providing services to a client according to section 245I.06.
 new text end

new text begin Subd. 41. new text end

new text begin Volunteer. new text end

new text begin "Volunteer" means an individual who, under the direction of the
license holder, provides services to or facilitates an activity for a client without compensation.
 new text end

Sec. 4.

new text begin [245I.03] REQUIRED POLICIES AND PROCEDURES.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin A license holder must establish, enforce, and maintain policies
and procedures to comply with the requirements of this chapter and chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; and Minnesota Rules, chapter 9544. The license
holder must make all policies and procedures available in writing to each staff person. The
license holder must complete and document a review of policies and procedures every two
years and update policies and procedures as necessary. Each policy and procedure must
identify the date that it was initiated and the dates of all revisions. The license holder must
clearly communicate any policy and procedural change to each staff person and provide
necessary training to each staff person to implement any policy and procedural change.
 new text end

new text begin Subd. 2. new text end

new text begin Health and safety. new text end

new text begin A license holder must have policies and procedures to
ensure the health and safety of each staff person and client during the provision of services,
including policies and procedures for services based in community settings.
 new text end

new text begin Subd. 3. new text end

new text begin Client rights. new text end

new text begin A license holder must have policies and procedures to ensure
that each staff person complies with the client rights and protections requirements in section
245I.12.
 new text end

new text begin Subd. 4. new text end

new text begin Behavioral emergencies. new text end

new text begin (a) A license holder must have procedures that each
staff person follows when responding to a client who exhibits behavior that threatens the
immediate safety of the client or others. A license holder's behavioral emergency procedures
must incorporate person-centered planning and trauma-informed care.
 new text end

new text begin (b) A license holder's behavioral emergency procedures must include:
 new text end

new text begin (1) a plan designed to prevent the client from inflicting self-harm and harming others;
 new text end

new text begin (2) contact information for emergency resources that a staff person must use when the
license holder's behavioral emergency procedures are unsuccessful in controlling a client's
behavior;
 new text end

new text begin (3) the types of behavioral emergency procedures that a staff person may use;
 new text end

new text begin (4) the specific circumstances under which the program may use behavioral emergency
procedures; and
 new text end

new text begin (5) the staff persons whom the license holder authorizes to implement behavioral
emergency procedures.
 new text end

new text begin (c) The license holder's behavioral emergency procedures must not include secluding
or restraining a client except as allowed under section 245.8261.
 new text end

new text begin (d) Staff persons must not use behavioral emergency procedures to enforce program
rules or for the convenience of staff persons. Behavioral emergency procedures must not
be part of any client's treatment plan. A staff person may not use behavioral emergency
procedures except in response to a client's current behavior that threatens the immediate
safety of the client or others.
 new text end

new text begin Subd. 5. new text end

new text begin Health services and medications. new text end

new text begin 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 reviews and approves of the license holder's policies and procedures to
comply with the health services and medications requirements in section 245I.11, the training
requirements in section 245I.05, subdivision 6, and the documentation requirements in
section 245I.08, subdivision 5.
 new text end

new text begin Subd. 6. new text end

new text begin Reporting unethical acts or maltreatment. new text end

new text begin (a) A license holder must have
policies and procedures for reporting and investigating a staff person's alleged unethical,
illegal, or grossly negligent acts, and a staff person's serious violations of policies and
procedures. A staff person's serious violation of policies and procedures means: (1) a violation
that threatens the health, safety, or rights of a client or other staff person; or (2) repeated
nonadherence to the license holder's policies and procedures. The license holder must
document that a supervisor reviewed the staff person's reported behavior. If the behavior is
substantiated, the license holder must document that the license holder took appropriate
disciplinary or corrective action.
 new text end

new text begin (b) A license holder must have policies and procedures for reporting a staff person's
suspected maltreatment, abuse, or neglect of a client according to chapter 260E and section
626.557.
 new text end

new text begin Subd. 7. new text end

new text begin Critical incidents. new text end

new text begin If a license holder is licensed as a residential program, the
license holder must have policies and procedures for reporting and maintaining records of
critical incidents according to section 245I.13.
 new text end

new text begin Subd. 8. new text end

new text begin Personnel. new text end

new text begin A license holder must have personnel policies and procedures that:
 new text end

new text begin (1) include a chart or description of the organizational structure of the program that
indicates positions and lines of authority;
 new text end

new text begin (2) ensure that it will not adversely affect a staff person's retention, promotion, job
assignment, or pay when a staff person communicates in good faith with the Department
of Human Services, the Office of Ombudsman for Mental Health and Developmental
Disabilities, the Department of Health, a health-related licensing board, a law enforcement
agency, or a local agency investigating a complaint regarding a client's rights, health, or
safety;
 new text end

new text begin (3) prohibit a staff person from having sexual contact with a client in violation of chapter
604, sections 609.344 or 609.345;
 new text end

new text begin (4) prohibit a staff person from neglecting, abusing, or maltreating a client as described
in chapter 260E and sections 626.557 and 626.5572;
 new text end

new text begin (5) include the drug and alcohol policy described in section 245A.04, subdivision 1,
paragraph (c);
 new text end

new text begin (6) describe the process for disciplinary action, suspension, or dismissal of a staff person
for violating a policy provision described in clauses (3) to (5);
 new text end

new text begin (7) describe the license holder's response to a staff person who violates other program
policies or who has a behavioral problem that interferes with providing treatment services
to clients; and
 new text end

new text begin (8) describe each staff person's position that includes the staff person's responsibilities,
authority to execute the responsibilities, and qualifications for the position.
 new text end

new text begin Subd. 9. new text end

new text begin Volunteers. new text end

new text begin A license holder must have policies and procedures for using
volunteers, including when a license holder must submit a background study for a volunteer,
and the specific tasks that a volunteer may perform.
 new text end

new text begin Subd. 10. new text end

new text begin Data privacy. new text end

new text begin (a) A license holder must have policies and procedures that
comply with the Minnesota Government Data Practices Act, chapter 13; the privacy
provisions of the Minnesota health care programs provider agreement; the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191; and the Minnesota
Health Records Act, sections 144.291 to 144.298. A license holder's use of electronic record
keeping or electronic signatures does not alter a license holder's obligations to comply with
applicable state and federal law.
 new text end

new text begin (b) A license holder must have policies and procedures for a staff person to promptly
document a client's revocation of consent to disclose the client's health record. The license
holder must verify that the license holder has permission to disclose a client's health record
before releasing any client data.
 new text end

Sec. 5.

new text begin [245I.04] PROVIDER QUALIFICATIONS AND SCOPE OF PRACTICE.
 new text end

new text begin Subdivision 1. new text end

new text begin Tribal providers. new text end

new text begin For purposes of this section, a tribal entity may
credential an individual according to section 256B.02, subdivision 7, paragraphs (b) and
(c).
 new text end

new text begin Subd. 2. new text end

new text begin Mental health professional qualifications. new text end

new text begin The following individuals may
provide services to a client as a mental health professional:
 new text end

new text begin (1) a registered nurse who is licensed under sections 148.171 to 148.285 and is certified
as a: (i) clinical nurse specialist in child or adolescent, family, or adult psychiatric and
mental health nursing by a national certification organization; or (ii) nurse practitioner in
adult or family psychiatric and mental health nursing by a national nurse certification
organization;
 new text end

new text begin (2) a licensed independent clinical social worker as defined in section 148E.050,
subdivision 5;
 new text end

new text begin (3) a psychologist licensed by the Board of Psychology under sections 148.88 to 148.98;
 new text end

new text begin (4) a physician licensed under chapter 147 if the physician is: (i) certified by the American
Board of Psychiatry and Neurology; (ii) certified by the American Osteopathic Board of
Neurology and Psychiatry; or (iii) eligible for board certification in psychiatry;
 new text end

new text begin (5) a marriage and family therapist licensed under sections 148B.29 to 148B.392; or
 new text end

new text begin (6) a licensed professional clinical counselor licensed under section 148B.5301.
 new text end

new text begin Subd. 3. new text end

new text begin Mental health professional scope of practice. new text end

new text begin A mental health professional
must maintain a valid license with the mental health professional's governing health-related
licensing board and must only provide services to a client within the scope of practice
determined by the applicable health-related licensing board.
 new text end

new text begin Subd. 4. new text end

new text begin Mental health practitioner qualifications. new text end

new text begin (a) An individual who is qualified
in at least one of the ways described in paragraph (b) to (d) may serve as a mental health
practitioner.
 new text end

new text begin (b) An individual is qualified as a mental health practitioner through relevant coursework
if the individual completes at least 30 semester hours or 45 quarter hours in behavioral
sciences or related fields and:
 new text end

new text begin (1) has at least 2,000 hours of experience providing services to individuals with:
 new text end

new text begin (i) a mental illness or a substance use disorder; or
 new text end

new text begin (ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to a client;
 new text end

new text begin (2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the individual's clients belong, and completes the additional training described in section
245I.05, subdivision 3, paragraph (c), before providing direct contact services to a client;
 new text end

new text begin (3) is working in a day treatment program under section 256B.0671, subdivision 3, or
256B.0943; or
 new text end

new text begin (4) has completed a practicum or internship that (i) required direct interaction with adult
clients or child clients, and (ii) was focused on behavioral sciences or related fields.
 new text end

new text begin (c) An individual is qualified as a mental health practitioner through work experience
providing services to clients if the individual:
 new text end

new text begin (1) has at least 4,000 hours of experience in the delivery of services to individuals with:
 new text end

new text begin (i) a mental illness or a substance use disorder; or
 new text end

new text begin (ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients; or
 new text end

new text begin (2) receives treatment supervision at least once per week until meeting the requirement
in clause (1) of 4,000 hours of experience and has at least 2,000 hours of experience providing
services to individuals with:
 new text end

new text begin (i) a mental illness or a substance use disorder; or
 new text end

new text begin (ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients.
 new text end

new text begin (d) An individual is qualified as a mental health practitioner if the individual has a
master's or other graduate degree in behavioral sciences or related fields.
 new text end

new text begin Subd. 5. new text end

new text begin Mental health practitioner scope of practice. new text end

new text begin (a) A mental health practitioner
under the treatment supervision of a mental health professional or certified rehabilitation
specialist may provide an adult client with client education, rehabilitative mental health
services, functional assessments, level of care assessments, and treatment plans. A mental
health practitioner under the treatment supervision of a mental health professional may
provide skill-building services to a child client and complete treatment plans for a child
client.
 new text end

new text begin (b) A mental health practitioner must not provide treatment supervision to other staff
persons. A mental health practitioner may provide direction to mental health rehabilitation
workers and mental health behavioral aides.
 new text end

new text begin (c) A mental health practitioner who provides services to clients according to section
256B.0624 may perform crisis assessments and interventions for a client.
 new text end

new text begin Subd. 6. new text end

new text begin Clinical trainee qualifications. new text end

new text begin (a) A clinical trainee is a staff person who: (1)
is enrolled in an accredited graduate program of study to prepare the staff person for
independent licensure as a mental health professional and who is participating in a practicum
or internship with the license holder through the individual's graduate program; or (2) has
completed an accredited graduate program of study to prepare the staff person for independent
licensure as a mental health professional and who is in compliance with the requirements
of the applicable health-related licensing board, including requirements for supervised
practice.
 new text end

new text begin (b) A clinical trainee is responsible for notifying and applying to a health-related licensing
board to ensure that the trainee meets the requirements of the health-related licensing board.
As permitted by a health-related licensing board, treatment supervision under this chapter
may be integrated into a plan to meet the supervisory requirements of the health-related
licensing board but does not supersede those requirements.
 new text end

new text begin Subd. 7. new text end

new text begin Clinical trainee scope of practice. new text end

new text begin (a) A clinical trainee under the treatment
supervision of a mental health professional may provide a client with psychotherapy, client
education, rehabilitative mental health services, diagnostic assessments, functional
assessments, level of care assessments, and treatment plans.
 new text end

new text begin (b) A clinical trainee must not provide treatment supervision to other staff persons. A
clinical trainee may provide direction to mental health behavioral aides and mental health
rehabilitation workers.
 new text end

new text begin (c) A psychological clinical trainee under the treatment supervision of a psychologist
may perform psychological testing of clients.
 new text end

new text begin (d) A clinical trainee must not provide services to clients that violate any practice act of
a health-related licensing board, including failure to obtain licensure if licensure is required.
 new text end

new text begin Subd. 8. new text end

new text begin Certified rehabilitation specialist qualifications. new text end

new text begin A certified rehabilitation
specialist must have:
 new text end

new text begin (1) a master's degree from an accredited college or university in behavioral sciences or
related fields;
 new text end

new text begin (2) at least 4,000 hours of post-master's supervised experience providing mental health
services to clients; and
 new text end

new text begin (3) a valid national certification as a certified rehabilitation counselor or certified
psychosocial rehabilitation practitioner.
 new text end

new text begin Subd. 9. new text end

new text begin Certified rehabilitation specialist scope of practice. new text end

new text begin (a) A certified
rehabilitation specialist may provide an adult client with client education, rehabilitative
mental health services, functional assessments, level of care assessments, and treatment
plans.
 new text end

new text begin (b) A certified rehabilitation specialist may provide treatment supervision to a mental
health certified peer specialist, mental health practitioner, and mental health rehabilitation
worker.
 new text end

new text begin Subd. 10. new text end

new text begin Mental health certified peer specialist qualifications. new text end

new text begin A mental health
certified peer specialist must:
 new text end

new text begin (1) have been diagnosed with a mental illness;
 new text end

new text begin (2) be a current or former mental health services client; and
 new text end

new text begin (3) have a valid certification as a mental health certified peer specialist under section
256B.0615.
 new text end

new text begin Subd. 11. new text end

new text begin Mental health certified peer specialist scope of practice. new text end

new text begin A mental health
certified peer specialist under the treatment supervision of a mental health professional or
certified rehabilitation specialist must:
 new text end

new text begin (1) provide individualized peer support to each client;
 new text end

new text begin (2) promote a client's recovery goals, self-sufficiency, self-advocacy, and development
of natural supports; and
 new text end

new text begin (3) support a client's maintenance of skills that the client has learned from other services.
 new text end

new text begin Subd. 12. new text end

new text begin Mental health certified family peer specialist qualifications. new text end

new text begin A mental
health certified family peer specialist must:
 new text end

new text begin (1) have raised or be currently raising a child with a mental illness;
 new text end

new text begin (2) have experience navigating the children's mental health system; and
 new text end

new text begin (3) have a valid certification as a mental health certified family peer specialist under
section 256B.0616.
 new text end

new text begin Subd. 13. new text end

new text begin Mental health certified family peer specialist scope of practice. new text end

new text begin A mental
health certified family peer specialist under the treatment supervision of a mental health
professional must provide services to increase the child's ability to function in the child's
home, school, and community. The mental health certified family peer specialist must:
 new text end

new text begin (1) provide family peer support to build on a client's family's strengths and help the
family achieve desired outcomes;
 new text end

new text begin (2) provide nonadversarial advocacy to a child client and the child's family that
encourages partnership and promotes the child's positive change and growth;
 new text end

new text begin (3) support families in advocating for culturally appropriate services for a child in each
treatment setting;
 new text end

new text begin (4) promote resiliency, self-advocacy, and development of natural supports;
 new text end

new text begin (5) support maintenance of skills learned from other services;
 new text end

new text begin (6) establish and lead parent support groups;
 new text end

new text begin (7) assist parents in developing coping and problem-solving skills; and
 new text end

new text begin (8) educate parents about mental illnesses and community resources, including resources
that connect parents with similar experiences to one another.
 new text end

new text begin Subd. 14. new text end

new text begin Mental health rehabilitation worker qualifications. new text end

new text begin (a) A mental health
rehabilitation worker must:
 new text end

new text begin (1) have a high school diploma or equivalent; and
 new text end

new text begin (2) meet one of the following qualification requirements:
 new text end

new text begin (i) be 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;
 new text end

new text begin (ii) have an associate of arts degree;
 new text end

new text begin (iii) have two years of full-time postsecondary education or a total of 15 semester hours
or 23 quarter hours in behavioral sciences or related fields;
 new text end

new text begin (iv) be a registered nurse;
 new text end

new text begin (v) have, within the previous ten years, three years of personal life experience with
mental illness;
 new text end

new text begin (vi) have, within the previous ten years, three years of life experience as a primary
caregiver to an adult with a mental illness, traumatic brain injury, substance use disorder,
or developmental disability; or
 new text end

new text begin (vii) have, within the previous ten years, 2,000 hours of work experience providing
health and human services to individuals.
 new text end

new text begin (b) A mental health rehabilitation worker who is scheduled as an overnight staff person
and works alone is exempt from the additional qualification requirements in paragraph (a),
clause (2).
 new text end

new text begin Subd. 15. new text end

new text begin Mental health rehabilitation worker scope of practice. new text end

new text begin A mental health
rehabilitation worker under the treatment supervision of a mental health professional or
certified rehabilitation specialist may provide rehabilitative mental health services to an
adult client according to the client's treatment plan.
 new text end

new text begin Subd. 16. new text end

new text begin Mental health behavioral aide qualifications. new text end

new text begin (a) A level 1 mental health
behavioral aide must have: (1) a high school diploma or equivalent; or (2) two years of
experience as a primary caregiver to a child with mental illness within the previous ten
years.
 new text end

new text begin (b) A level 2 mental health behavioral aide must: (1) have an associate or bachelor's
degree; or (2) be certified by a program under section 256B.0943, subdivision 8a.
 new text end

new text begin Subd. 17. new text end

new text begin Mental health behavioral aide scope of practice. new text end

new text begin While under the treatment
supervision of a mental health professional, a mental health behavioral aide may practice
psychosocial skills with a child client according to the child's treatment plan and individual
behavior plan that a mental health professional, clinical trainee, or mental health practitioner
has previously taught to the child.
 new text end

Sec. 6.

new text begin [245I.05] TRAINING REQUIRED.
 new text end

new text begin Subdivision 1. new text end

new text begin Training plan. new text end

new text begin A license holder must develop a training plan to ensure
that staff persons receive ongoing training according to this section. The training plan must
include:
 new text end

new text begin (1) a formal process to evaluate the training needs of each staff person. An annual
performance evaluation of a staff person satisfies this requirement;
 new text end

new text begin (2) a description of how the license holder conducts ongoing training of each staff person,
including whether ongoing training is based on a staff person's hire date or a specified annual
cycle determined by the program;
 new text end

new text begin (3) a description of how the license holder verifies and documents each staff person's
previous training experience. A license holder may consider a staff person to have met a
training requirement in subdivision 3, paragraph (d) or (e), if the staff person has received
equivalent postsecondary education in the previous four years or training experience in the
previous two years; and
 new text end

new text begin (4) a description of how the license holder determines when a staff person needs
additional training, including when the license holder will provide additional training.
 new text end

new text begin Subd. 2. new text end

new text begin Documentation of training. new text end

new text begin (a) The license holder must provide training to
each staff person according to the training plan and must document that the license holder
provided the training to each staff person. The license holder must document the following
information for each staff person's training:
 new text end

new text begin (1) the topics of the training;
 new text end

new text begin (2) the name of the trainee;
 new text end

new text begin (3) the name and credentials of the trainer;
 new text end

new text begin (4) the license holder's method of evaluating the trainee's competency upon completion
of training;
 new text end

new text begin (5) the date of the training; and
 new text end

new text begin (6) the length of training in hours and minutes.
 new text end

new text begin (b) Documentation of a staff person's continuing education credit accepted by the
governing health-related licensing board is sufficient to document training for purposes of
this subdivision.
 new text end

new text begin Subd. 3. new text end

new text begin Initial training. new text end

new text begin (a) A staff person must receive training about:
 new text end

new text begin (1) vulnerable adult maltreatment under section 245A.65, subdivision 3; and
 new text end

new text begin (2) the maltreatment of minor reporting requirements and definitions in chapter 260E
within 72 hours of first providing direct contact services to a client.
 new text end

new text begin (b) Before providing direct contact services to a client, a staff person must receive training
about:
 new text end

new text begin (1) client rights and protections under section 245I.12;
 new text end

new text begin (2) the Minnesota Health Records Act, including client confidentiality, family engagement
under section 144.294, and client privacy;
 new text end

new text begin (3) emergency procedures that the staff person must follow when responding to a fire,
inclement weather, a report of a missing person, and a behavioral or medical emergency;
 new text end

new text begin (4) specific activities and job functions for which the staff person is responsible, including
the license holder's program policies and procedures applicable to the staff person's position;
 new text end

new text begin (5) professional boundaries that the staff person must maintain; and
 new text end

new text begin (6) specific needs of each client to whom the staff person will be providing direct contact
services, including each client's developmental status, cognitive functioning, physical and
mental abilities.
 new text end

new text begin (c) Before providing direct contact services to a client, a mental health rehabilitation
worker, mental health behavioral aide, or mental health practitioner qualified under section
245I.04, subdivision 4, must receive 30 hours of training about:
 new text end

new text begin (1) mental illnesses;
 new text end

new text begin (2) client recovery and resiliency;
 new text end

new text begin (3) mental health de-escalation techniques;
 new text end

new text begin (4) co-occurring mental illness and substance use disorders; and
 new text end

new text begin (5) psychotropic medications and medication side effects.
 new text end

new text begin (d) Within 90 days of first providing direct contact services to an adult client, a clinical
trainee, mental health practitioner, mental health certified peer specialist, or mental health
rehabilitation worker must receive training about:
 new text end

new text begin (1) trauma-informed care and secondary trauma;
 new text end

new text begin (2) person-centered individual treatment plans, including seeking partnerships with
family and other natural supports;
 new text end

new text begin (3) co-occurring substance use disorders; and
 new text end

new text begin (4) culturally responsive treatment practices.
 new text end

new text begin (e) Within 90 days of first providing direct contact services to a child client, a clinical
trainee, mental health practitioner, mental health certified family peer specialist, mental
health certified peer specialist, or mental health behavioral aide must receive training about
the topics in clauses (1) to (5). This training must address the developmental characteristics
of each child served by the license holder and address the needs of each child in the context
of the child's family, support system, and culture. Training topics must include:
 new text end

new text begin (1) trauma-informed care and secondary trauma, including adverse childhood experiences
(ACEs);
 new text end

new text begin (2) family-centered treatment plan development, including seeking partnership with a
child client's family and other natural supports;
 new text end

new text begin (3) mental illness and co-occurring substance use disorders in family systems;
 new text end

new text begin (4) culturally responsive treatment practices; and
 new text end

new text begin (5) child development, including cognitive functioning, and physical and mental abilities.
 new text end

new text begin (f) For a mental health behavioral aide, the training under paragraph (e) must include
parent team training using a curriculum approved by the commissioner.
 new text end

new text begin Subd. 4. new text end

new text begin Ongoing training. new text end

new text begin (a) A license holder must ensure that staff persons who
provide direct contact services to clients receive annual training about the topics in
subdivision 3, paragraphs (a) and (b), clauses (1) to (3).
 new text end

new text begin (b) A license holder must ensure that each staff person who is qualified under section
245I.04 who is not a mental health professional receives 30 hours of training every two
years. The training topics must be based on the program's needs and the staff person's areas
of competency.
 new text end

new text begin Subd. 5. new text end

new text begin Additional training for medication administration. new text end

new text begin (a) Prior to administering
medications to a client under delegated authority or observing a client self-administer
medications, a staff person who is not a licensed prescriber, registered nurse, or licensed
practical nurse qualified under section 148.171, subdivision 8, must receive training about
psychotropic medications, side effects, and safe medication management.
 new text end

new text begin (b) Prior to administering medications to a client under delegated authority, a staff person
must successfully complete a:
 new text end

new text begin (1) medication administration training program for unlicensed personnel through an
accredited Minnesota postsecondary educational institution with completion of the course
documented in writing and placed in the staff person's personnel file; or
 new text end

new text begin (2) formalized training program taught by a registered nurse or licensed prescriber that
is offered by the license holder. A staff person's successful completion of the formalized
training program must include direct observation of the staff person to determine the staff
person's areas of competency.
 new text end

Sec. 7.

new text begin [245I.06] TREATMENT SUPERVISION.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) A license holder must ensure that a mental health
professional or certified rehabilitation specialist provides treatment supervision to each staff
person who provides services to a client and who is not a mental health professional or
certified rehabilitation specialist. When providing treatment supervision, a treatment
supervisor must follow a staff person's written treatment supervision plan.
 new text end

new text begin (b) Treatment supervision must focus on each client's treatment needs and the ability of
the staff person under treatment supervision to provide services to each client, including
the following topics related to the staff person's current caseload:
 new text end

new text begin (1) a review and evaluation of the interventions that the staff person delivers to each
client;
 new text end

new text begin (2) instruction on alternative strategies if a client is not achieving treatment goals;
 new text end

new text begin (3) a review and evaluation of each client's assessments, treatment plans, and progress
notes for accuracy and appropriateness;
 new text end

new text begin (4) instruction on the cultural norms or values of the clients and communities that the
license holder serves and the impact that a client's culture has on providing treatment;
 new text end

new text begin (5) evaluation of and feedback regarding a direct service staff person's areas of
competency; and
 new text end

new text begin (6) coaching, teaching, and practicing skills with a staff person.
 new text end

new text begin (c) A treatment supervisor's responsibility for a staff person receiving treatment
supervision is limited to the services provided by the associated license holder. If a staff
person receiving treatment supervision is employed by multiple license holders, each license
holder is responsible for providing treatment supervision related to the treatment of the
license holder's clients.
 new text end

new text begin Subd. 2. new text end

new text begin Types of treatment supervision. new text end

new text begin (a) A treatment supervisor must provide
treatment supervision to a staff person using methods that allow for immediate feedback,
including in-person, telephone, and interactive video supervision.
 new text end

new text begin (b) Treatment supervisors may provide treatment supervision to a staff person
individually, or in a group. "Individual supervision" means that one or more treatment
supervisors are providing one staff person with treatment supervision. "Group supervision"
means one or more treatment supervisors are providing two to ten staff persons with treatment
supervision.
 new text end

new text begin Subd. 3. new text end

new text begin Treatment supervision planning. new text end

new text begin (a) A treatment supervisor and the staff
person supervised by the treatment supervisor must develop a written treatment supervision
plan. The license holder must ensure that a new staff person's treatment supervision plan is
completed and implemented by a treatment supervisor and the new staff person within 30
days of the new staff person's first day of employment. The license holder must review and
update each staff person's treatment supervision plan annually.
 new text end

new text begin (b) Each staff person's treatment supervision plan must include:
 new text end

new text begin (1) the name and qualifications of the staff person receiving treatment supervision;
 new text end

new text begin (2) the name of the license holder from whom the staff person is receiving treatment
supervision;
 new text end

new text begin (3) the names and licensures of the treatment supervisors who are supervising the staff
person;
 new text end

new text begin (4) how frequently the treatment supervisors must provide treatment supervision to the
staff person;
 new text end

new text begin (5) the location of the staff person's treatment supervision record if the license holder
does not keep the record in the staff person's personnel file;
 new text end

new text begin (6) procedures that the staff person must use to respond to client emergencies; and
 new text end

new text begin (7) the staff person's authorized scope of practice, including a description of the staff
person's job responsibilities with the license holder, a description of the client population
that the staff person serves, and a description of the treatment methods and modalities that
the staff person may use to provide services to clients.
 new text end

new text begin Subd. 4. new text end

new text begin Treatment supervision record. new text end

new text begin (a) A license holder must ensure that treatment
supervision of each staff person is documented in each staff person's treatment supervision
record.
 new text end

new text begin (b) Each staff person's treatment supervision record must include:
 new text end

new text begin (1) the dates and duration of the staff person's treatment supervision;
 new text end

new text begin (2) whether the staff person was under treatment supervision individually or in a group;
 new text end

new text begin (3) subsequent actions that the staff person receiving treatment supervision must take;
and
 new text end

new text begin (4) the name, title, and dated signature of the person who provided treatment supervision.
 new text end

new text begin Subd. 5. new text end

new text begin Treatment supervision and direct observation of mental health
rehabilitation workers and mental health behavioral aides. new text end

new text begin (a) A mental health behavioral
aide or a mental health rehabilitation worker must receive direct observation from a mental
health professional, clinical trainee, certified rehabilitation specialist, or mental health
practitioner while the mental health behavioral aide or mental health rehabilitation worker
provides treatment services to clients, no less than twice per month for the first six months
of employment and once per month thereafter. The staff person performing the direct
observation must approve of the progress note for the observed treatment service.
 new text end

new text begin (b) For a mental health rehabilitation worker qualified under section 245I.04, subdivision
14, paragraph (a), clause (2), item (i), treatment supervision in the first 2,000 hours of work
must at a minimum consist of:
 new text end

new text begin (1) monthly individual supervision; and
 new text end

new text begin (2) direct observation twice per month.
 new text end

Sec. 8.

new text begin [245I.07] PERSONNEL FILES.
 new text end

new text begin (a) For each staff person, a license holder must maintain a personnel file that includes:
 new text end

new text begin (1) verification of the staff person's qualifications required for the position including
training, education, practicum or internship agreement, licensure, and any other required
qualifications;
 new text end

new text begin (2) documentation related to the staff person's background study;
 new text end

new text begin (3) the hiring date of the staff person;
 new text end

new text begin (4) the date that the staff person's specific duties and responsibilities became effective,
including the date that the staff person began having direct contact with clients;
 new text end

new text begin (5) documentation of the staff person's training as required by section 245I.05, subdivision
2;
 new text end

new text begin (6) documentation of license renewals that the staff person completed during the staff
person's employment;
 new text end

new text begin (7) annual job performance evaluations;
 new text end

new text begin (8) if applicable, the staff person's alleged and substantiated violations of the license
holder's policies under section 245I.03, subdivision 8, clauses (3) to (7), and the license
holder's response; and
 new text end

new text begin (9) the staff person's treatment supervision record under section 245I.06, subdivision 4,
if applicable.
 new text end

new text begin (b) The license holder must ensure that all personnel files are readily accessible for the
commissioner's review. The license holder is not required to keep personnel files in a single
location.
 new text end

Sec. 9.

new text begin [245I.08] DOCUMENTATION STANDARDS.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin A license holder must ensure that all documentation required
by this chapter complies with this section.
 new text end

new text begin Subd. 2. new text end

new text begin Documentation standards. new text end

new text begin A license holder must ensure that all documentation
required by this chapter:
 new text end

new text begin (1) is legible;
 new text end

new text begin (2) identifies the applicable client and staff person on each page; and
 new text end

new text begin (3) is signed and dated by the staff persons who provided services to the client or
completed the documentation, including the staff persons' credentials.
 new text end

new text begin Subd. 3. new text end

new text begin Documenting approval. new text end

new text begin A license holder must ensure that all diagnostic
assessments, functional assessments, level of care assessments, and treatment plans completed
by a clinical trainee or mental health practitioner contain documentation of approval by a
treatment supervisor within five business days of initial completion by the staff person under
treatment supervision.
 new text end

new text begin Subd. 4. new text end

new text begin Progress notes. new text end

new text begin A license holder must use a progress note to promptly document
each occurrence of a mental health service that a staff person provides to a client. A progress
note must include the following:
 new text end

new text begin (1) the type of service;
 new text end

new text begin (2) the date of service;
 new text end

new text begin (3) the start and stop time of the service unless the license holder is licensed as a
residential program;
 new text end

new text begin (4) the location of the service;
 new text end

new text begin (5) the scope of the service, including: (i) the targeted goal and objective; (ii) the
intervention that the staff person provided to the client and the methods that the staff person
used; (iii) the client's response to the intervention; (iv) the staff person's plan to take future
actions, including changes in treatment that the staff person will implement if the intervention
was ineffective; and (v) the service modality;
 new text end

new text begin (6) the signature, printed name, and credentials of the staff person who provided the
service to the client;
 new text end

new text begin (7) the mental health provider travel documentation required by section 256B.0625, if
applicable; and
 new text end

new text begin (8) significant observations by the staff person, if applicable, including: (i) the client's
current risk factors; (ii) emergency interventions by staff persons; (iii) consultations with
or referrals to other professionals, family, or significant others; and (iv) changes in the
client's mental or physical symptoms.
 new text end

new text begin Subd. 5. new text end

new text begin Medication administration record. new text end

new text begin If a license holder administers or observes
a client self-administer medications, the license holder must maintain a medication
administration record for each client that contains the following, as applicable:
 new text end

new text begin (1) the client's date of birth;
 new text end

new text begin (2) the client's allergies;
 new text end

new text begin (3) all medication orders for the client, including client-specific orders for
over-the-counter medications and approved condition-specific protocols;
 new text end

new text begin (4) the name of each ordered medication, date of each medication's expiration, each
medication's dosage frequency, method of administration, and time;
 new text end

new text begin (5) the licensed prescriber's name and telephone number;
 new text end

new text begin (6) the date of initiation;
 new text end

new text begin (7) the signature, printed name, and credentials of the staff person who administered the
medication or observed the client self-administer the medication; and
 new text end

new text begin (8) the reason that the license holder did not administer the client's prescribed medication
or observe the client self-administer the client's prescribed medication.
 new text end

Sec. 10.

new text begin [245I.09] CLIENT FILES.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) A license holder must maintain a file for each client that
contains the client's current and accurate records. The license holder must store each client
file on the premises where the license holder provides or coordinates services for the client.
The license holder must ensure that all client files are readily accessible for the
commissioner's review. The license holder is not required to keep client files in a single
location.
 new text end

new text begin (b) The license holder must protect client records against loss, tampering, or unauthorized
disclosure of confidential client data according to the Minnesota Government Data Practices
Act, chapter 13; the privacy provisions of the Minnesota health care programs provider
agreement; the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
Public Law 104-191; and the Minnesota Health Records Act, sections 144.291 to 144.298.
 new text end

new text begin Subd. 2. new text end

new text begin Record retention. new text end

new text begin A license holder must retain client records of a discharged
client for a minimum of seven years from the date of the client's discharge. A license holder
who ceases to provide treatment services to a client must retain the client's records for a
minimum of seven years from the date that the license holder stopped providing services
to the client and must notify the commissioner of the location of the client records and the
name of the individual responsible for storing and maintaining the client records.
 new text end

new text begin Subd. 3. new text end

new text begin Contents. new text end

new text begin A license holder must retain a clear and complete record of the
information that the license holder receives regarding a client, and of the services that the
license holder provides to the client. If applicable, each client's file must include the following
information:
 new text end

new text begin (1) the client's screenings, assessments, and testing;
 new text end

new text begin (2) the client's treatment plans and reviews of the client's treatment plan;
 new text end

new text begin (3) the client's individual abuse prevention plans;
 new text end

new text begin (4) the client's health care directive under section 145C.01, subdivision 5a, and the
client's emergency contacts;
 new text end

new text begin (5) the client's crisis plans;
 new text end

new text begin (6) the client's consents for releases of information and documentation of the client's
releases of information;
 new text end

new text begin (7) the client's significant medical and health-related information;
 new text end

new text begin (8) a record of each communication that a staff person has with the client's other mental
health providers and persons interested in the client, including the client's case manager,
family members, primary caregiver, legal representatives, court representatives,
representatives from the correctional system, or school administration;
 new text end

new text begin (9) written information by the client that the client requests to include in the client's file;
and
 new text end

new text begin (10) the date of the client's discharge from the license holder's program, the reason that
the license holder discontinued services for the client, and the client's discharge summaries.
 new text end

Sec. 11.

new text begin [245I.10] ASSESSMENT AND TREATMENT PLANNING.
 new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) "Diagnostic formulation" means a written analysis and
explanation of a client's clinical assessment to develop a hypothesis about the cause and
nature of a client's presenting problems and to identify the most suitable approach for treating
the client.
 new text end

new text begin (b) "Responsivity factors" means the factors other than the diagnostic formulation that
may modify a client's treatment needs. This includes a client's learning style, abilities,
cognitive functioning, cultural background, and personal circumstances. When documenting
a client's responsivity factors a mental health professional or clinical trainee must include
an analysis of how a client's strengths are reflected in the license holder's plan to deliver
services to the client.
 new text end

new text begin Subd. 2. new text end

new text begin Generally. new text end

new text begin (a) A license holder must use a client's diagnostic assessment or
crisis assessment to determine a client's eligibility for mental health services, except as
provided in this section.
 new text end

new text begin (b) Prior to completing a client's initial diagnostic assessment, a license holder may
provide a client with the following services:
 new text end

new text begin (1) an explanation of the license holder's findings;
 new text end

new text begin (2) neuropsychological testing, neuropsychological assessment, and psychological
testing;
 new text end

new text begin (3) any combination of psychotherapy sessions, family psychotherapy sessions, and
family psychoeducation sessions not to exceed three sessions;
 new text end

new text begin (4) crisis assessment services according to section 256B.0624; and
 new text end

new text begin (5) ten days of intensive residential treatment services according to the assessment and
treatment planning standards in section 245.23, subdivision 7.
 new text end

new text begin (c) Based on the client's needs that a crisis assessment identifies under section 256B.0624,
a license holder may provide a client with the following services:
 new text end

new text begin (1) crisis intervention and stabilization services under section 245I.23 or 256B.0624;
and
 new text end

new text begin (2) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization.
 new text end

new text begin (d) Based on the client's needs in the client's brief diagnostic assessment, a license holder
may provide a client with any combination of psychotherapy sessions, group psychotherapy
sessions, family psychotherapy sessions, and family psychoeducation sessions not to exceed
ten sessions within a 12-month period without prior authorization for any new client or for
an existing client who the license holder projects will need fewer than ten sessions during
the next 12 months.
 new text end

new text begin (e) Based on the client's needs that a hospital's medical history and presentation
examination identifies, a license holder may provide a client with:
 new text end

new text begin (1) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization for any new client or for an existing
client who the license holder projects will need fewer than ten sessions during the next 12
months; and
 new text end

new text begin (2) up to five days of day treatment services or partial hospitalization.
 new text end

new text begin (f) A license holder must complete a new standard diagnostic assessment of a client:
 new text end

new text begin (1) when the client requires services of a greater number or intensity than the services
that paragraphs (b) to (e) describe;
 new text end

new text begin (2) at least annually following the client's initial diagnostic assessment if the client needs
additional mental health services and the client does not meet the criteria for a brief
assessment;
 new text end

new text begin (3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; or
 new text end

new text begin (4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis.
 new text end

new text begin (g) For an existing client, the license holder must ensure that a new standard diagnostic
assessment includes a written update containing all significant new or changed information
about the client, and an update regarding what information has not significantly changed,
including a discussion with the client about changes in the client's life situation, functioning,
presenting problems, and progress with achieving treatment goals since the client's last
diagnostic assessment was completed.
 new text end

new text begin Subd. 3. new text end

new text begin Continuity of services. new text end

new text begin (a) For any client with a diagnostic assessment
completed under Minnesota Rules, parts 9505.0370 to 9505.0372, before the effective date
of this section, the diagnostic assessment is valid for authorizing the client's treatment and
billing for one calendar year after the date that the assessment was completed.
 new text end

new text begin (b) For any client with an individual treatment plan completed under section 256B.0622,
256B.0623, 256B.0943, 256B.0946, or 256B.0947 or Minnesota Rules, parts 9505.0370 to
9505.0372, the client's treatment plan is valid for authorizing treatment and billing until the
treatment plan's expiration date.
 new text end

new text begin (c) This subdivision expires July 1, 2023.
 new text end

new text begin Subd. 4. new text end

new text begin Diagnostic assessment. new text end

new text begin A client's diagnostic assessment must: (1) identify at
least one mental health diagnosis for which the client meets the diagnostic criteria and
recommend mental health services to develop the client's mental health services and treatment
plan; or (2) include a finding that the client does not meet the criteria for a mental health
disorder.
 new text end

new text begin Subd. 5. new text end

new text begin Brief diagnostic assessment; required elements. new text end

new text begin (a) Only a mental health
professional or clinical trainee may complete a brief diagnostic assessment of a client. A
license holder may only use a brief diagnostic assessment for a client who is six years of
age or older.
 new text end

new text begin (b) When conducting a brief diagnostic assessment of a client, the assessor must complete
a face-to-face interview with the client and a written evaluation of the client. The assessor
must gather and document initial components of the client's standard diagnostic assessment,
including the client's:
 new text end

new text begin (1) age;
 new text end

new text begin (2) description of symptoms, including the reason for the client's referral;
 new text end

new text begin (3) history of mental health treatment;
 new text end

new text begin (4) cultural influences on the client; and
 new text end

new text begin (5) mental status examination.
 new text end

new text begin (c) Based on the initial components of the assessment, the assessor must develop a
provisional diagnostic formulation about the client. The assessor may use the client's
provisional diagnostic formulation to address the client's immediate needs and presenting
problems.
 new text end

new text begin (d) A mental health professional or clinical trainee may use treatment sessions with the
client authorized by a brief diagnostic assessment to gather additional information about
the client to complete the client's standard diagnostic assessment if the number of sessions
will exceed the coverage limits in subdivision 2.
 new text end

new text begin Subd. 6. new text end

new text begin Standard diagnostic assessment; required elements. new text end

new text begin (a) Only a mental health
professional or a clinical trainee may complete a standard diagnostic assessment of a client.
A standard diagnostic assessment of a client must include a face-to-face interview with a
client and a written evaluation of the client. The assessor must complete a client's standard
diagnostic assessment within the client's cultural context.
 new text end

new text begin (b) When completing a standard diagnostic assessment of a client, the assessor must
gather and document information about the client's current life situation, including the
following information:
 new text end

new text begin (1) the client's age;
 new text end

new text begin (2) the client's current living situation, including the client's housing status and household
members;
 new text end

new text begin (3) the status of the client's basic needs;
 new text end

new text begin (4) the client's education level and employment status;
 new text end

new text begin (5) the client's current medications;
 new text end

new text begin (6) any immediate risks to the client's health and safety;
 new text end

new text begin (7) the client's perceptions of the client's condition;
 new text end

new text begin (8) the client's description of the client's symptoms, including the reason for the client's
referral;
 new text end

new text begin (9) the client's history of mental health treatment; and
 new text end

new text begin (10) cultural influences on the client.
 new text end

new text begin (c) If the assessor cannot obtain the information that this subdivision requires without
retraumatizing the client or harming the client's willingness to engage in treatment, the
assessor must identify which topics will require further assessment during the course of the
client's treatment. The assessor must gather and document information related to the following
topics:
 new text end

new text begin (1) the client's relationship with the client's family and other significant personal
relationships, including the client's evaluation of the quality of each relationship;
 new text end

new text begin (2) the client's strengths and resources, including the extent and quality of the client's
social networks;
 new text end

new text begin (3) important developmental incidents in the client's life;
 new text end

new text begin (4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;
 new text end

new text begin (5) the client's history of or exposure to alcohol and drug usage and treatment; and
 new text end

new text begin (6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.
 new text end

new text begin (d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.
 new text end

new text begin (1) When completing a standard diagnostic assessment of a client who is five years of
age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood
published by Zero to Three.
 new text end

new text begin (2) When completing a standard diagnostic assessment of a client who is six years of
age or older, the assessor must use the current edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.
 new text end

new text begin (3) When completing a standard diagnostic assessment of a client who is five years of
age or younger, an assessor must administer the Early Childhood Service Intensity Instrument
(ECSII) to the client and include the results in the client's assessment.
 new text end

new text begin (4) When completing a standard diagnostic assessment of a client who is six to 17 years
of age, an assessor must administer the Child and Adolescent Service Intensity Instrument
(CASII) to the client and include the results in the client's assessment.
 new text end

new text begin (5) When completing a standard diagnostic assessment of a client who is 18 years of
age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the criteria
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association to screen and assess the client for a
substance use disorder.
 new text end

new text begin (e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:
 new text end

new text begin (1) the client's mental status examination;
 new text end

new text begin (2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources;
vulnerabilities; safety needs, including client information that supports the assessor's findings
after applying a recognized diagnostic framework from paragraph (d); and any differential
diagnosis of the client;
 new text end

new text begin (3) an explanation of: (i) how the assessor diagnosed the client using the information
from the client's interview, assessment, psychological testing, and collateral information
about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths;
and (v) the client's responsivity factors.
 new text end

new text begin (f) When completing a standard diagnostic assessment of a client, the assessor must
consult the client and the client's family about which services that the client and the family
prefer to treat the client. The assessor must make referrals for the client as to services required
by law.
 new text end

new text begin Subd. 7. new text end

new text begin Individual treatment plan. new text end

new text begin A license holder must follow each client's written
individual treatment plan when providing services to the client with the following exceptions:
 new text end

new text begin (1) services that do not require that a license holder completes a standard diagnostic
assessment of a client before providing services to the client;
 new text end

new text begin (2) when developing a service plan; and
 new text end

new text begin (3) when a client re-engages in services under subdivision 8, clause (8).
 new text end

new text begin Subd. 8. new text end

new text begin Individual treatment plan; required elements. new text end

new text begin After completing a client's
diagnostic assessment and before providing services to the client, the license holder must
complete the client's individual treatment plan. The license holder must:
 new text end

new text begin (1) base the client's individual treatment plan on the client's diagnostic assessment and
baseline measurements;
 new text end

new text begin (2) for a child client, use a child-centered, family-driven, and culturally appropriate
planning process that allows the child's parents and guardians to observe and participate in
the child's individual and family treatment services, assessments, and treatment planning;
 new text end

new text begin (3) for an adult client, use a person-centered, culturally appropriate planning process
that allows the client's family and other natural supports to observe and participate in the
client's treatment services, assessments, and treatment planning;
 new text end

new text begin (4) identify the client's treatment goals, measureable treatment objectives, a schedule
for accomplishing the client's treatment goals and objectives, a treatment strategy, and the
individuals responsible for providing treatment services and supports to the client. The
license holder must have a treatment strategy to engage the client in treatment if the client:
 new text end

new text begin (i) has a history of not engaging in treatment; and
 new text end

new text begin (ii) is ordered by a court to participate in treatment services or to take neuroleptic
medications;
 new text end

new text begin (5) identify the participants involved in the client's treatment planning. The client must
be a participant in the client's treatment planning. If applicable, the license holder must
document the reasons that the license holder did not involve the client's family or other
natural supports in the client's treatment planning;
 new text end

new text begin (6) review the client's individual treatment plan every 180 days and update the client's
individual treatment plan with the client's treatment progress, new treatment objectives and
goals or, if the client has not made treatment progress, changes in the license holder's
approach to treatment; and
 new text end

new text begin (7) ensure that the client approves of the client's individual treatment plan unless a court
orders the client's treatment plan under chapter 253B.
 new text end

new text begin If the client disagrees with the client's treatment plan, the license holder must document the
client file with the reasons why the client does not agree with the treatment plan. If the
license holder cannot obtain the client's approval of the treatment plan, a mental health
professional must make efforts to obtain approval from a person who is authorized to consent
on the client's behalf within 30 days after the client's previous individual treatment plan
expired. A license holder may not deny a client service during this time period solely because
the license holder could not obtain the client's approval of the client's individual treatment
plan. A license holder may continue to bill for the client's otherwise eligible services when
the client re-engages in services.
 new text end

new text begin Subd. 9. new text end

new text begin Functional assessment; required elements. new text end

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

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

new text begin (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;
 new text end

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

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

new text begin (i) the client's mental health symptoms;
 new text end

new text begin (ii) the client's mental health service needs;
 new text end

new text begin (iii) the client's substance use;
 new text end

new text begin (iv) the client's vocational and educational functioning;
 new text end

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

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

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

new text begin (viii) the client's medical and dental health;
 new text end

new text begin (ix) the client's financial assistance needs; and
 new text end

new text begin (x) the client's housing and transportation needs;
 new text end

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

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

new text begin (7) 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 end

Sec. 12.

new text begin [245I.11] HEALTH SERVICES AND MEDICATIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin 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 end

new text begin Subd. 2. new text end

new text begin Health services. new text end

new text begin If a license holder is licensed as a residential program, the
license holder must:
 new text end

new text begin (1) ensure that a client is screened for health issues within 72 hours of the client's
admission;
 new text end

new text begin (2) monitor the physical health needs of each client on an ongoing basis;
 new text end

new text begin (3) offer referrals to clients and coordinate each client's care with psychiatric and medical
services;
 new text end

new text begin (4) identify circumstances in which a staff person must notify a registered nurse or
licensed prescriber of any of a client's health concerns and the process for providing
notification of client health concerns; and
 new text end

new text begin (5) identify the circumstances in which the license holder must obtain medical care for
a client and the process for obtaining medical care for a client.
 new text end

new text begin Subd. 3. new text end

new text begin Storing and accounting for medications. new text end

new text begin (a) If a license holder stores client
medications, the license holder must:
 new text end

new text begin (1) store client medications in original containers in a locked location;
 new text end

new text begin (2) store refrigerated client medications in special trays or containers that are separate
from food;
 new text end

new text begin (3) store client medications marked "for external use only" in a compartment that is
separate from other client medications;
 new text end

new text begin (4) store Schedule II to IV drugs listed in section 152.02, subdivisions 3 to 5, in a
compartment that is locked separately from other medications;
 new text end

new text begin (5) ensure that only authorized staff persons have access to stored client medications;
 new text end

new text begin (6) follow a documentation procedure on each shift to account for all scheduled drugs;
and
 new text end

new text begin (7) record each incident when a staff person accepts a supply of client medications and
destroy discontinued, outdated, or deteriorated client medications.
 new text end

new text begin (b) If a license holder is licensed as a residential program, the license holder must allow
clients who self-administer medications to keep a private medication supply. The license
holder must ensure that the client stores all private medication in a locked container in the
client's private living area, unless the private medication supply poses a health and safety
risk to any clients. A client must not maintain a private medication supply of a prescription
medication without a written medication order from a licensed prescriber and a prescription
label that includes the client's name.
 new text end

new text begin Subd. 4. new text end

new text begin Medication orders. new text end

new text begin (a) If a license holder stores, prescribes, or administers
medications or observes a client self-administer medications, the license holder must:
 new text end

new text begin (1) ensure that a licensed prescriber writes all orders to accept, administer, or discontinue
client medications;
 new text end

new text begin (2) accept nonwritten orders to administer client medications in emergency circumstances
only;
 new text end

new text begin (3) establish a timeline and process for obtaining a written order with the licensed
prescriber's signature when the license holder accepts a nonwritten order to administer client
medications;
 new text end

new text begin (4) obtain prescription medication renewals from a licensed prescriber for each client
every 90 days for psychotropic medications and annually for all other medications; and
 new text end

new text begin (5) maintain the client's right to privacy and dignity.
 new text end

new text begin (b) If a license holder employs a licensed prescriber, the license holder must inform the
client about potential medication effects and side effects and obtain and document the client's
informed consent before the licensed prescriber prescribes a medication.
 new text end

new text begin Subd. 5. new text end

new text begin Medication administration. new text end

new text begin If a license holder is licensed as a residential
program, the license holder must:
 new text end

new text begin (1) assess and document each client's ability to self-administer medication. In the
assessment, the license holder must evaluate the client's ability to: (i) comply with prescribed
medication regimens; and (ii) store the client's medications safely and in a manner that
protects other individuals in the facility. Through the assessment process, the license holder
must assist the client in developing the skills necessary to safely self-administer medication;
 new text end

new text begin (2) monitor the effectiveness of medications, side effects of medications, and adverse
reactions to medications for each client. The license holder must promptly address and
document any concerns about a client's medications;
 new text end

new text begin (3) ensure that no staff person or client gives a legend drug supply for one client to
another client;
 new text end

new text begin (4) have policies and procedures for: (i) keeping a record of each client's medication
orders; (ii) keeping a record of any incident of deferring a client's medications; (iii)
documenting any incident when a client's medication is omitted; and (iv) documenting when
a client refuses to take medications as prescribed; and
 new text end

new text begin (5) document and track medication errors, document whether the license holder notified
anyone about the medication error, determine if the license holder must take any follow-up
actions, and identify the staff persons who are responsible for taking follow-up actions.
 new text end

Sec. 13.

new text begin [245I.12] CLIENT RIGHTS AND PROTECTIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Client rights. new text end

new text begin A license holder must ensure that all clients have the
following rights:
 new text end

new text begin (1) the rights listed in the health care bill of rights in section 144.651;
 new text end

new text begin (2) the right to be free from discrimination based on age, race, color, creed, religion,
national origin, gender, marital status, disability, sexual orientation, and status with regard
to public assistance. The license holder must follow all applicable state and federal laws
including the Minnesota Human Rights Act, chapter 363A; and
 new text end

new text begin (3) the right to be informed prior to a photograph or audio or video recording being made
of the client. The client has the right to refuse to allow any recording or photograph of the
client that is not for the purposes of identification or supervision by the license holder.
 new text end

new text begin Subd. 2. new text end

new text begin Restrictions to client rights. new text end

new text begin If the license holder restricts a client's right, the
license holder must document in the client file a mental health professional's approval of
the restriction and the reasons for the restriction.
 new text end

new text begin Subd. 3. new text end

new text begin Notice of rights. new text end

new text begin The license holder must give a copy of the client's rights
according to this section to each client on the day of the client's admission. The license
holder must document that the license holder gave a copy of the client's rights to each client
on the day of the client's admission according to this section. The license holder must post
a copy of the client rights in an area visible or accessible to all clients. The license holder
must include the client rights in Minnesota Rules, chapter 9544, for applicable clients.
 new text end

new text begin Subd. 4. new text end

new text begin Client property. new text end

new text begin (a) The license holder must meet the requirements of section
245A.04, subdivision 13.
 new text end

new text begin (b) If the license holder is unable to obtain a client's signature acknowledging the receipt
of the client's funds or property required by section 245A.04, subdivision 13, paragraph (c),
clause (1), two staff persons must sign documentation acknowledging that the staff persons
witnessed the client's receipt of the client's funds or property.
 new text end

new text begin (c) The license holder must return all of the client's funds and other property to the client
except for the following items:
 new text end

new text begin (1) illicit drugs, drug paraphernalia, and drug containers that are subject to forfeiture
under section 609.5316. The license holder must give illicit drugs, drug paraphernalia, and
drug containers to a local law enforcement agency or destroy the items; and
 new text end

new text begin (2) weapons, explosives, and other property that may cause serious harm to the client
or others. The license holder may give a client's weapons and explosives to a local law
enforcement agency. The license holder must notify the client that a local law enforcement
agency has the client's property and that the client has the right to reclaim the property if
the client has a legal right to possess the item.
 new text end

new text begin (d) If a client leaves the license holder's program but abandons the client's funds or
property, the license holder must retain and store the client's funds or property, including
medications, for a minimum of 30 days after the client's discharge from the program.
 new text end

new text begin Subd. 5. new text end

new text begin Client grievances. new text end

new text begin (a) The license holder must have a grievance procedure
that:
 new text end

new text begin (1) describes to clients how the license holder will meet the requirements in this
subdivision; and
 new text end

new text begin (2) contains the current telephone numbers, e-mail addresses, and mailing addresses of
the Department of Human Services, Licensing Division; the Office of Ombudsman for
Mental Health and Developmental Disabilities; the Department of Health, Office of Health
Facilities Complaints; and all applicable health-related licensing boards.
 new text end

new text begin (b) On the day of each client's admission, the license holder must explain the grievance
procedure to the client.
 new text end

new text begin (c) The license holder must:
 new text end

new text begin (1) post the grievance procedure in a place visible to clients and provide a copy of the
grievance procedure upon request;
 new text end

new text begin (2) allow clients, former clients, and their authorized representatives to submit a grievance
to the license holder;
 new text end

new text begin (3) within three business days of receiving a client's grievance, acknowledge in writing
that the license holder received the client's grievance and provide the client with the date
by which the license holder will respond to the client's grievance. If applicable, the license
holder must include a notice of the client's separate appeal rights for a managed care
organization's reduction, termination, or denial of a covered service;
 new text end

new text begin (4) within 15 business days of receiving a client's grievance, provide a written final
response to the client's grievance containing the license holder's official response to the
grievance; and
 new text end

new text begin (5) allow the client to bring a grievance to the person with the highest level of authority
in the program.
 new text end

Sec. 14.

new text begin [245I.13] CRITICAL INCIDENTS.
 new text end

new text begin If a license holder is licensed as a residential program, the license holder must report all
critical incidents to the commissioner within ten days of learning of the incident on a form
approved by the commissioner. The license holder must keep a record of critical incidents
in a central location that is readily accessible to the commissioner for review upon the
commissioner's request for a minimum of two licensing periods.
 new text end

Sec. 15.

new text begin [245I.20] MENTAL HEALTH CLINIC.
 new text end

new text begin Subdivision 1. new text end

new text begin Purpose. new text end

new text begin Certified mental health clinics provide clinical services for the
treatment of mental illnesses with a treatment team that reflects multiple disciplines and
areas of expertise.
 new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) "Clinical services" means services provided to a client to
diagnose, describe, predict, and explain the client's status relative to a condition or problem
as described in the: (1) current edition of the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association; or (2) current edition of the
DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy
and Early Childhood published by Zero to Three. Where necessary, clinical services includes
services to treat a client to reduce the client's impairment due to the client's condition.
Clinical services also includes individual treatment planning, case review, record-keeping
required for a client's treatment, and treatment supervision. For the purposes of this section,
clinical services excludes services delivered to a client under a separate license and services
certified by the commissioner.
 new text end

new text begin (b) "Competent" means having professional education, training, continuing education,
consultation, supervision, experience, or a combination thereof necessary to demonstrate
sufficient knowledge of and proficiency in a specific clinical service.
 new text end

new text begin (c) "Discipline" means a branch of professional knowledge or skill acquired through a
specific course of study, training, and supervised practice. Discipline is usually documented
by a specific educational degree, licensure, or certification of proficiency. Examples of the
mental health disciplines include but are not limited to psychiatry, psychology, clinical
social work, marriage and family therapy, clinical counseling, and psychiatric nursing.
 new text end

new text begin (d) "Treatment team" means the mental health professionals, mental health practitioners,
and clinical trainees who provide clinical services to clients.
 new text end

new text begin Subd. 3. new text end

new text begin Organizational structure. new text end

new text begin (a) A mental health clinic location must be an entire
facility or a clearly identified unit within a facility that is administratively and clinically
separate from the rest of the facility. The mental health clinic location may provide services
other than clinical services to clients, including medical services, substance use disorder
services, social services, training, and education.
 new text end

new text begin (b) The certification holder must notify the commissioner of all mental health clinic
locations. If there is more than one mental health clinic location, the certification holder
must designate one location as the main location and all of the other locations as satellite
locations. The main location as a unit and the clinic as a whole must comply with the
minimum staffing standards in subdivision 4.
 new text end

new text begin (c) The certification holder must ensure that each satellite location:
 new text end

new text begin (1) adheres to the same policies and procedures as the main location;
 new text end

new text begin (2) provides clients with face-to-face or telephone access to a mental health professional
whenever the satellite location is open. The certification holder must maintain a schedule
of the mental health professionals who will be available and the contact information for
each available mental health professional. The schedule must be current and readily available
to treatment team members; and
 new text end

new text begin (3) enables clients to access all of the mental health clinic's clinical services and treatment
team members, as needed.
 new text end

new text begin Subd. 4. new text end

new text begin Minimum staffing standards. new text end

new text begin (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 of the two mental health professionals must specialize
in a different mental health discipline.
 new text end

new text begin (b) The treatment team must include:
 new text end

new text begin (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
 new text end

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

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

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

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

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

new text begin (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.
 new text end

new text begin (d) A certification holder may have additional mental health professional staff persons,
provided that no more than 60 percent of the full-time equivalent mental health professional
staff specializes in a single mental health discipline. This provision does not apply to a
certification holder with fewer than six full-time equivalent mental health professional staff.
 new text end

new text begin (e) The certification holder must maintain a record that demonstrates compliance with
this subdivision.
 new text end

new text begin Subd. 5. new text end

new text begin Treatment supervision specified. new text end

new text begin (a) A mental health professional must remain
responsible for each client's case. The certification holder must document the name of the
mental health professional responsible for each case and the dates that the mental health
professional is responsible for the client's case from beginning date to end date. The
certification holder must assign each client's case for assessment, diagnosis, and treatment
services to a treatment team member who is competent in the assigned clinical service, the
recommended treatment strategy, and in treating the client's characteristics.
 new text end

new text begin (b) Treatment supervision of mental health practitioners and clinical trainees required
by section 245I.06 must include case reviews as described in this paragraph. Every two
months, a mental health professional must complete a case review of each client assigned
to the mental health professional when the client is receiving clinical services from a mental
health practitioner or clinical trainee. The case review must include a consultation process
that thoroughly examines the client's condition and treatment, including: (1) a review of the
client's reason for seeking treatment, diagnoses and assessments, and the individual treatment
plan; (2) a review of the appropriateness, duration, and outcome of treatment provided to
the client; and (3) treatment recommendations.
 new text end

new text begin Subd. 6. new text end

new text begin Additional policy and procedure requirements. new text end

new text begin (a) In addition to the policies
and procedures required by section 245I.03, the certification holder must establish, enforce,
and maintain the policies and procedures required by this subdivision.
 new text end

new text begin (b) The certification holder must have a clinical evaluation procedure to identify and
document each treatment team member's areas of competence.
 new text end

new text begin (c) The certification holder must have policies and procedures for client intake and case
assignment that:
 new text end

new text begin (1) outline the client intake process;
 new text end

new text begin (2) describe how the mental health clinic determines the appropriateness of accepting a
client into treatment by reviewing the client's condition and need for treatment, the clinical
services that the mental health clinic offers to clients, and other available resources; and
 new text end

new text begin (3) contain a process for assigning a client's case to a mental health professional who is
responsible for the client's case and other treatment team members.
 new text end

new text begin Subd. 7. new text end

new text begin Referrals. new text end

new text begin If necessary treatment for a client or treatment desired by a client
is not available at the mental health clinic, the certification holder must facilitate appropriate
referrals for the client. When making a referral for a client, the treatment team member must
document a discussion with the client that includes: (1) the reason for the client's referral;
(2) potential treatment resources for the client; and (3) the client's response to receiving a
referral.
 new text end

new text begin Subd. 8. new text end

new text begin Emergency service. new text end

new text begin For the certification holder's telephone numbers that clients
regularly access, the certification holder must include the contact information for the area's
mental health crisis services as part of the certification holder's message when a live operator
is not available to answer clients' calls.
 new text end

new text begin Subd. 9. new text end

new text begin Quality assurance and improvement plan. new text end

new text begin (a) At a minimum, a certification
holder must develop a written quality assurance and improvement plan that includes a plan
for:
 new text end

new text begin (1) encouraging ongoing consultation among members of the treatment team;
 new text end

new text begin (2) obtaining and evaluating feedback about services from clients, family and other
natural supports, referral sources, and staff persons;
 new text end

new text begin (3) measuring and evaluating client outcomes;
 new text end

new text begin (4) reviewing client suicide deaths and suicide attempts;
 new text end

new text begin (5) examining the quality of clinical service delivery to clients;
 new text end

new text begin (6) examining the efficiency of resource usage; and
 new text end

new text begin (7) self-monitoring of compliance with this chapter.
 new text end

new text begin (b) At least annually, the certification holder must review, evaluate, and update the
quality assurance and improvement plan. The review must: (1) include documentation of
the actions that the certification holder will take as a result of information obtained from
monitoring activities in the plan; and (2) establish goals for improved service delivery to
clients for the next year.
 new text end

new text begin Subd. 10. new text end

new text begin Application procedures. new text end

new text begin (a) The applicant for certification must submit any
documents that the commissioner requires on forms approved by the commissioner.
 new text end

new text begin (b) Upon submitting an application for certification, an applicant must pay the application
fee required by section 245A.10, subdivision 3.
 new text end

new text begin (c) The commissioner must respond to an application within 90 working days of receiving
a completed application.
 new text end

new text begin (d) When the commissioner receives an application for initial certification that is
incomplete because the applicant failed to submit required documents or is deficient because
the submitted documents do not meet certification requirements, the commissioner must
provide the applicant with written notice that the application is incomplete or deficient. In
the notice, the commissioner must identify the particular documents that are missing or
deficient and give the applicant 45 days to submit a second application that is complete. An
applicant's failure to submit a complete application within 45 days after receiving notice
from the commissioner is a basis for certification denial.
 new text end

new text begin (e) The commissioner must give notice of a denial to an applicant when the commissioner
has made the decision to deny the certification application. In the notice of denial, the
commissioner must state the reasons for the denial in plain language. The commissioner
must send or deliver the notice of denial to an applicant by certified mail or personal service.
In the notice of denial, the commissioner must state the reasons that the commissioner denied
the application and must inform the applicant of the applicant's right to request a contested
case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The
applicant may appeal the denial by notifying the commissioner in writing by certified mail
or personal service. If mailed, the appeal must be postmarked and sent to the commissioner
within 20 calendar days after the applicant received the notice of denial. If an applicant
delivers an appeal by personal service, the commissioner must receive the appeal within 20
calendar days after the applicant received the notice of denial.
 new text end

new text begin Subd. 11. new text end

new text begin Commissioner's right of access. new text end

new text begin (a) When the commissioner is exercising
the powers conferred to the commissioner by this chapter, if the mental health clinic is in
operation and the information is relevant to the commissioner's inspection or investigation,
the mental health clinic must provide the commissioner access to:
 new text end

new text begin (1) the physical facility and grounds where the program is located;
 new text end

new text begin (2) documentation and records, including electronically maintained records;
 new text end

new text begin (3) clients served by the mental health clinic;
 new text end

new text begin (4) staff persons of the mental health clinic; and
 new text end

new text begin (5) personnel records of current and former staff employed by the mental health clinic.
 new text end

new text begin (b) The mental health clinic must provide the commissioner with access to the facility,
records, clients, and staff without prior notice and as often as the commissioner considers
necessary if the commissioner is investigating alleged maltreatment or a violation of a law
or rule, or conducting an inspection. When conducting an inspection, the commissioner
may request and must receive assistance from other state, county, and municipal
governmental agencies and departments. The applicant or certification holder must allow
the commissioner, at the commissioner's expense, to photocopy, photograph, and make
audio and video recordings during an inspection.
 new text end

new text begin Subd. 12. new text end

new text begin Monitoring and inspections. new text end

new text begin (a) The commissioner may conduct a certification
review of the certified mental health clinic every two years to determine the clinic's
compliance with applicable rules and statutes.
 new text end

new text begin (b) The commissioner must make the results of certification reviews and investigations
publicly available on the department's website.
 new text end

new text begin Subd. 13. new text end

new text begin Correction orders. new text end

new text begin (a) If the applicant or certification holder fails to comply
with a law or rule, the commissioner may issue a correction order. The correction order
must state:
 new text end

new text begin (1) the condition that constitutes a violation of the law or rule;
 new text end

new text begin (2) the specific law or rule that the applicant or certification holder has violated; and
 new text end

new text begin (3) the time that the applicant or certification holder is allowed to correct each violation.
 new text end

new text begin (b) If the applicant or certification holder believes that the commissioner's correction
order is erroneous, the applicant or certification holder may ask the commissioner to
reconsider the part of the correction order that is allegedly erroneous. An applicant or
certification holder must make a request for reconsideration in writing. The request must
be postmarked and sent to the commissioner within 20 calendar days after the applicant or
certification holder received the correction order; and the request must:
 new text end

new text begin (1) specify the part of the correction order that is allegedly erroneous;
 new text end

new text begin (2) explain why the specified part is erroneous; and
 new text end

new text begin (3) include documentation to support the allegation of error.
 new text end

new text begin (c) A request for reconsideration does not stay any provision or requirement of the
correction order. The commissioner's disposition of a request for reconsideration is final
and not subject to appeal.
 new text end

new text begin (d) If the commissioner finds that the applicant or certification holder failed to correct
the violation specified in the correction order, the commissioner may decertify the certified
mental health clinic according to subdivision 14.
 new text end

new text begin (e) Nothing in this subdivision prohibits the commissioner from decertifying a mental
health clinic according to subdivision 14.
 new text end

new text begin Subd. 14. new text end

new text begin Decertification. new text end

new text begin (a) The commissioner may decertify a mental health clinic
if a certification holder:
 new text end

new text begin (1) failed to comply with an applicable law or rule; or
 new text end

new text begin (2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, during an
investigation, or regarding compliance with applicable laws or rules.
 new text end

new text begin (b) When considering decertification of a mental health clinic, the commissioner must
consider the nature, chronicity, or severity of the violation of law or rule and the effect of
the violation on the health, safety, or rights of clients.
 new text end

new text begin (c) If the commissioner decertifies a mental health clinic, the order of decertification
must inform the certification holder of the right to have a contested case hearing under
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The certification holder
may appeal the decertification. The certification holder must appeal a decertification in
writing and send or deliver the appeal to the commissioner by certified mail or personal
service. If the certification holder mails the appeal, the appeal must be postmarked and sent
to the commissioner within ten calendar days after the certification holder receives the order
of decertification. If the certification holder delivers an appeal by personal service, the
commissioner must receive the appeal within ten calendar days after the certification holder
received the order. If a certification holder submits a timely appeal of an order of
decertification, the certification holder may continue to operate the program until the
commissioner issues a final order on the decertification.
 new text end

new text begin (d) If the commissioner decertifies a mental health clinic pursuant to paragraph (a),
clause (1), based on a determination that the mental health clinic was responsible for
maltreatment, and if the mental health clinic requests reconsideration of the decertification
according to paragraph (c), and appeals the maltreatment determination under section
260E.33, the final decertification determination is stayed until the commissioner issues a
final decision regarding the maltreatment appeal.
 new text end

Sec. 16.

new text begin [245I.23] INTENSIVE RESIDENTIAL TREATMENT SERVICES AND
RESIDENTIAL CRISIS STABILIZATION.
 new text end

new text begin Subdivision 1. new text end

new text begin Purpose. new text end

new text begin (a) Intensive residential treatment services is a community-based
medically monitored level of care for an adult client that uses established rehabilitative
principles to promote a client's recovery and to develop and achieve psychiatric stability,
personal and emotional adjustment, self-sufficiency, and other skills that help a client
transition to a more independent setting.
 new text end

new text begin (b) Residential crisis stabilization provides structure and support to an adult client in a
community living environment when a client has experienced a mental health crisis and
needs short-term services to ensure that the client can safely return to the client's home or
precrisis living environment with additional services and supports identified in the client's
crisis assessment.
 new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) "Program location" means a set of rooms that are each physically
self-contained and have defining walls extending from floor to ceiling. Program location
includes bedrooms, living rooms or lounge areas, bathrooms, and connecting areas.
 new text end

new text begin (b) "Treatment team" means a group of staff persons who provide intensive residential
treatment services or residential crisis stabilization to clients. The treatment team includes
mental health professionals, mental health practitioners, clinical trainees, certified
rehabilitation specialists, mental health rehabilitation workers, and mental health certified
peer specialists.
 new text end

new text begin Subd. 3. new text end

new text begin Treatment services description. new text end

new text begin The license holder must describe in writing
all treatment services that the license holder provides. The license holder must have the
description readily available for the commissioner upon the commissioner's request.
 new text end

new text begin Subd. 4. new text end

new text begin Required intensive residential treatment services. new text end

new text begin (a) On a daily basis, the
license holder must follow a client's treatment plan to provide intensive residential treatment
services to the client to improve the client's functioning.
 new text end

new text begin (b) The license holder must offer and have the capacity to directly provide the following
treatment services to each client:
 new text end

new text begin (1) rehabilitative mental health services;
 new text end

new text begin (2) crisis prevention planning to assist a client with:
 new text end

new text begin (i) identifying and addressing patterns in the client's history and experience of the client's
mental illness; and
 new text end

new text begin (ii) developing crisis prevention strategies that include de-escalation strategies that have
been effective for the client in the past;
 new text end

new text begin (3) health services and administering medication;
 new text end

new text begin (4) co-occurring substance use disorder treatment;
 new text end

new text begin (5) engaging the client's family and other natural supports in the client's treatment and
educating the client's family and other natural supports to strengthen the client's social and
family relationships; and
 new text end

new text begin (6) making referrals for the client to other service providers in the community and
supporting the client's transition from intensive residential treatment services to another
setting.
 new text end

new text begin (c) The license holder must include Illness Management and Recovery (IMR), Enhanced
Illness Management and Recovery (E-IMR), or other similar interventions in the license
holder's programming as approved by the commissioner.
 new text end

new text begin Subd. 5. new text end

new text begin Required residential crisis stabilization services. new text end

new text begin (a) On a daily basis, the
license holder must follow a client's individual crisis treatment plan to provide services to
the client in residential crisis stabilization to improve the client's functioning.
 new text end

new text begin (b) The license holder must offer and have the capacity to directly provide the following
treatment services to the client:
 new text end

new text begin (1) crisis stabilization services as described in section 256B.0624, subdivision 7;
 new text end

new text begin (2) rehabilitative mental health services;
 new text end

new text begin (3) health services and administering the client's medications; and
 new text end

new text begin (4) making referrals for the client to other service providers in the community and
supporting the client's transition from residential crisis stabilization to another setting.
 new text end

new text begin Subd. 6. new text end

new text begin Optional treatment services. new text end

new text begin (a) If the license holder offers additional treatment
services to a client, the treatment service must be:
 new text end

new text begin (1) approved by the commissioner; and
 new text end

new text begin (2)(i) a mental health evidence-based practice that the federal Department of Health and
Human Services Substance Abuse and Mental Health Service Administration has adopted;
 new text end

new text begin (ii) a nationally recognized mental health service that substantial research has validated
as effective in helping individuals with serious mental illness achieve treatment goals; or
 new text end

new text begin (iii) developed under state-sponsored research of publicly funded mental health programs
and validated to be effective for individuals, families, and communities.
 new text end

new text begin (b) Before providing an optional treatment service to a client, the license holder must
provide adequate training to a staff person about providing the optional treatment service
to a client.
 new text end

new text begin Subd. 7. new text end

new text begin Intensive residential treatment services assessment and treatment
planning. new text end

new text begin (a) Within 12 hours of a client's admission, the license holder must evaluate and
document the client's immediate needs, including the client's:
 new text end

new text begin (1) health and safety, including the client's need for crisis assistance;
 new text end

new text begin (2) responsibilities for children, family and other natural supports, and employers; and
 new text end

new text begin (3) housing and legal issues.
 new text end

new text begin (b) Within 24 hours of the client's admission, the license holder must complete an initial
treatment plan for the client. The license holder must:
 new text end

new text begin (1) base the client's initial treatment plan on the client's referral information and an
assessment of the client's immediate needs;
 new text end

new text begin (2) consider crisis assistance strategies that have been effective for the client in the past;
 new text end

new text begin (3) identify the client's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the client engage in treatment;
 new text end

new text begin (4) identify the participants involved in the client's treatment planning. The client must
be a participant; and
 new text end

new text begin (5) ensure that a treatment supervisor approves of the client's initial treatment plan if a
mental health practitioner or clinical trainee completes the client's treatment plan,
notwithstanding section 245I.08, subdivision 3.
 new text end

new text begin (c) According to section 245A.65, subdivision 2, paragraph (b), the license holder must
complete an individual abuse prevention plan as part of a client's initial treatment plan.
 new text end

new text begin (d) Within five days of the client's admission and again within 60 days after the client's
admission, the license holder must complete a level of care assessment of the client. If the
license holder determines that a client does not need a medically monitored level of service,
a treatment supervisor must document how the client's admission to and continued services
in intensive residential treatment services are medically necessary for the client.
 new text end

new text begin (e) Within ten days of a client's admission, the license holder must complete or review
and update the client's standard diagnostic assessment.
 new text end

new text begin (f) Within ten days of a client's admission, the license holder must complete the client's
individual treatment plan, notwithstanding section 245I.10, subdivision 8. Within 40 days
after the client's admission and again within 70 days after the client's admission, the license
holder must update the client's individual treatment plan. The license holder must focus the
client's treatment planning on preparing the client for a successful transition from intensive
residential treatment services to another setting. In addition to the required elements of an
individual treatment plan under section 245I.10, subdivision 8, the license holder must
identify the following information in the client's individual treatment plan: (1) the client's
referrals and resources for the client's health and safety; and (2) the staff persons who are
responsible for following up with the client's referrals and resources. If the client does not
receive a referral or resource that the client needs, the license holder must document the
reason that the license holder did not make the referral or did not connect the client to a
particular resource. The license holder is responsible for determining whether additional
follow-up is required on behalf of the client.
 new text end

new text begin (g) Within 30 days of the client's admission, the license holder must complete a functional
assessment of the client. Within 60 days after the client's admission, the license holder must
update the client's functional assessment to include any changes in the client's functioning
and symptoms.
 new text end

new text begin (h) For a client with a current substance use disorder diagnosis and for a client whose
substance use disorder screening in the client's standard diagnostic assessment indicates the
possibility that the client has a substance use disorder, the license holder must complete a
written assessment of the client's substance use within 30 days of the client's admission. In
the substance use assessment, the license holder must: (1) evaluate the client's history of
substance use, relapses, and hospitalizations related to substance use; (2) assess the effects
of the client's substance use on the client's relationships including with family member and
others; (3) identify financial problems, health issues, housing instability, and unemployment;
(4) assess the client's legal problems, past and pending incarceration, violence, and
victimization; and (5) evaluate the client's suicide attempts, noncompliance with taking
prescribed medications, and noncompliance with psychosocial treatment.
 new text end

new text begin (i) On a weekly basis, the license holder must review each client's treatment plan and
individual abuse prevention plan. The license holder must document in the client's file each
weekly review of the client's treatment plan and individual abuse prevention plan.
 new text end

new text begin Subd. 8. new text end

new text begin Residential crisis stabilization assessment and treatment planning. new text end

new text begin (a)
Within 12 hours of a client's admission, the license holder must evaluate the client and
document the client's immediate needs, including the client's:
 new text end

new text begin (1) health and safety, including the client's need for crisis assistance;
 new text end

new text begin (2) responsibilities for children, family and other natural supports, and employers; and
 new text end

new text begin (3) housing and legal issues.
 new text end

new text begin (b) Within 24 hours of a client's admission, the license holder must complete a crisis
treatment plan for the client under section 256B.0624, subdivision 11. The license holder
must base the client's crisis treatment plan on the client's referral information and an
assessment of the client's immediate needs.
 new text end

new text begin (c) Section 245A.65, subdivision 2, paragraph (b), requires the license holder to complete
an individual abuse prevention plan for a client as part of the client's crisis treatment plan.
 new text end

new text begin Subd. 9. new text end

new text begin Key staff positions. new text end

new text begin (a) The license holder must have a staff person assigned
to each of the following key staff positions at all times:
 new text end

new text begin (1) a program director who qualifies as a mental health practitioner. The license holder
must designate the program director as responsible for all aspects of the operation of the
program and the program's compliance with all applicable requirements. The program
director must know and understand the implications of this chapter; chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; Minnesota Rules, chapter 9544; and all other
applicable requirements. The license holder must document in the program director's
personnel file how the program director demonstrates knowledge of these requirements.
The program director may also serve as the treatment director of the program, if qualified;
 new text end

new text begin (2) a treatment director who qualifies as a mental health professional. The treatment
director must be responsible for overseeing treatment services for clients and the treatment
supervision of all staff persons; and
 new text end

new text begin (3) a registered nurse who qualifies as a mental health practitioner. The registered nurse
must:
 new text end

new text begin (i) work at the program location a minimum of eight hours per week;
 new text end

new text begin (ii) provide monitoring and supervision of staff persons as defined in section 148.171,
subdivisions 8a and 23;
 new text end

new text begin (iii) be responsible for the review and approval of health service and medication policies
and procedures under section 245I.03, subdivision 5; and
 new text end

new text begin (iv) oversee the license holder's provision of health services to clients, medication storage,
and medication administration to clients.
 new text end

new text begin (b) Within five business days of a change in a key staff position, the license holder must
notify the commissioner of the staffing change. The license holder must notify the
commissioner of the staffing change on a form approved by the commissioner and include
the name of the staff person now assigned to the key staff position and the staff person's
qualifications.
 new text end

new text begin Subd. 10. new text end

new text begin Minimum treatment team staffing levels and ratios. new text end

new text begin (a) The license holder
must maintain a treatment team staffing level sufficient to:
 new text end

new text begin (1) provide continuous daily coverage of all shifts;
 new text end

new text begin (2) follow each client's treatment plan and meet each client's needs as identified in the
client's treatment plan;
 new text end

new text begin (3) implement program requirements; and
 new text end

new text begin (4) safely monitor and guide the activities of each client, taking into account the client's
level of behavioral and psychiatric stability, cultural needs, and vulnerabilities.
 new text end

new text begin (b) The license holder must ensure that treatment team members:
 new text end

new text begin (1) remain awake during all work hours; and
 new text end

new text begin (2) are available to monitor and guide the activities of each client whenever clients are
present in the program.
 new text end

new text begin (c) On each shift, the license holder must maintain a treatment team staffing ratio of at
least one treatment team member to nine clients. If the license holder is serving nine or
fewer clients, at least one treatment team member on the day shift must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
If the license holder is serving more than nine clients, at least one of the treatment team
members working during both the day and evening shifts must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
 new text end

new text begin (d) If the license holder provides residential crisis stabilization to clients and is serving
at least one client in residential crisis stabilization and more than four clients in residential
crisis stabilization and intensive residential treatment services, the license holder must
maintain a treatment team staffing ratio on each shift of at least two treatment team members
during the client's first 48 hours in residential crisis stabilization.
 new text end

new text begin Subd. 11. new text end

new text begin Shift exchange. new text end

new text begin A license holder must ensure that treatment team members
working on different shifts exchange information about a client as necessary to effectively
care for the client and to follow and update a client's treatment plan and individual abuse
prevention plan.
 new text end

new text begin Subd. 12. new text end

new text begin Daily documentation. new text end

new text begin (a) For each day that a client is present in the program,
the license holder must provide a daily summary in the client's file that includes observations
about the client's behavior and symptoms, including any critical incidents in which the client
was involved.
 new text end

new text begin (b) For each day that a client is not present in the program, the license holder must
document the reason for a client's absence in the client's file.
 new text end

new text begin Subd. 13. new text end

new text begin Access to a mental health professional, clinical trainee, certified
rehabilitation specialist, or mental health practitioner. new text end

new text begin Treatment team members must
have access in person or by telephone to a mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitioner within 30 minutes. The license
holder must maintain a schedule of mental health professionals, clinical trainees, certified
rehabilitation specialists, or mental health practitioners who will be available and contact
information to reach them. The license holder must keep the schedule current and make the
schedule readily available to treatment team members.
 new text end

new text begin Subd. 14. new text end

new text begin Treatment supervision. new text end

new text begin (a) Treatment supervision under section 245I.06
includes the use of team supervision. "Team supervision" means:
 new text end

new text begin (1) one or more treatment supervisors providing treatment supervision to any number
of treatment team members; or
 new text end

new text begin (2) weekly team meetings and ancillary meetings according to paragraph (b).
 new text end

new text begin (b) If the license holder holds weekly team meetings and ancillary meetings to provide
team supervision to team members:
 new text end

new text begin (1) the treatment director must hold at least one team meeting each calendar week and
be physically present at each team meeting. 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. The license holder must document all weekly team meetings, including
the names of meeting attendees; and
 new text end

new text begin (2) 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.
 new text end

new text begin Subd. 15. new text end

new text begin Intensive residential treatment services admission criteria. new text end

new text begin (a) An eligible
client for intensive residential treatment services is an individual who:
 new text end

new text begin (1) is age 18 or older;
 new text end

new text begin (2) is diagnosed with a mental illness;
 new text end

new text begin (3) because of a mental illness, has a substantial disability and functional impairment
in three or more areas listed in section 245I.10, subdivision 9, clause (4), that markedly
reduce the individual's self-sufficiency;
 new text end

new text begin (4) has one or more of the following: a history of recurring or prolonged inpatient
hospitalizations during the past year, significant independent living instability, homelessness,
or very frequent use of mental health and related services with poor outcomes for the
individual; and
 new text end

new text begin (5) in the written opinion of a mental health professional, needs mental health services
that available community-based services cannot provide, or is likely to experience a mental
health crisis or require a more restrictive setting if the individual does not receive intensive
rehabilitative mental health services.
 new text end

new text begin (b) The license holder must not limit or restrict intensive residential treatment services
to a client based solely on:
 new text end

new text begin (1) the client's substance use;
 new text end

new text begin (2) the county in which the client resides; or
 new text end

new text begin (3) whether the client elects to receive other services for which the client may be eligible,
including case management services.
 new text end

new text begin (c) This subdivision does not prohibit the license holder from restricting admissions of
individuals who present an imminent risk of harm or danger to themselves or others.
 new text end

new text begin Subd. 16. new text end

new text begin Residential crisis stabilization services admission criteria. new text end

new text begin An eligible client
for residential crisis stabilization is an individual who is age 18 or older and meets the
eligibility criteria in section 256B.0624, subdivision 3.
 new text end

new text begin Subd. 17. new text end

new text begin Admissions referrals and determinations. new text end

new text begin (a) The license holder must
identify the information that the license holder needs to make a determination about a
person's admission referral.
 new text end

new text begin (b) The license holder must:
 new text end

new text begin (1) always be available to receive referral information about a person seeking admission
to the license holder's program;
 new text end

new text begin (2) respond to the referral source within eight hours of receiving a referral and, within
eight hours, communicate with the referral source about what information the license holder
needs to make a determination concerning the person's admission;
 new text end

new text begin (3) consider the license holder's staffing ratio and the areas of treatment team members'
competency when determining whether the license holder is able to meet the needs of a
person seeking admission; and
 new text end

new text begin (4) determine whether to admit a person within 72 hours of receiving all necessary
information from the referral source.
 new text end

new text begin Subd. 18. new text end

new text begin Discharge standards. new text end

new text begin (a) To successfully discharge a client from a program,
the license holder must ensure that the following criteria are met:
 new text end

new text begin (1) the client must substantially meet the client's documented treatment plan goals and
objectives;
 new text end

new text begin (2) the client must complete discharge planning with the treatment team; and
 new text end

new text begin (3) the client and treatment team must arrange for the client to receive continuing care
at a less intensive level of care after discharge.
 new text end

new text begin (b) Prior to successfully discharging a client from a program, the license holder must
complete the client's discharge summary and provide the client with a copy of the client's
discharge summary in plain language that includes:
 new text end

new text begin (1) a brief review of the client's problems and strengths during the period that the license
holder provided services to the client;
 new text end

new text begin (2) the client's response to the client's treatment plan;
 new text end

new text begin (3) the goals and objectives that the license holder recommends that the client addresses
during the first three months following the client's discharge from the program;
 new text end

new text begin (4) the recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting;
 new text end

new text begin (5) the client's crisis plan; and
 new text end

new text begin (6) the client's forwarding address and telephone number.
 new text end

new text begin (c) For a non-program-initiated discharge of a client from a program, the following
criteria must be met:
 new text end

new text begin (1)(i) the client has withdrawn the client's consent for treatment; (ii) the license holder
has determined that the client has the capacity to make an informed decision; and (iii) the
client does not meet the criteria for an emergency hold under section 253B.051, subdivision
2;
 new text end

new text begin (2) the client has left the program against staff person advice;
 new text end

new text begin (3) an entity with legal authority to remove the client has decided to remove the client
from the program; or
 new text end

new text begin (4) a source of payment for the services is no longer available.
 new text end

new text begin (d) Within ten days of a non-program-initiated discharge of a client from a program, the
license holder must complete the client's discharge summary in plain language that includes:
 new text end

new text begin (1) the reasons for the client's discharge;
 new text end

new text begin (2) a description of attempts by staff persons to enable the client to continue treatment
or to consent to treatment; and
 new text end

new text begin (3) recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting.
 new text end

new text begin (e) For a program-initiated discharge of a client from a program, the following criteria
must be met:
 new text end

new text begin (1) the client is competent but has not participated in treatment or has not followed the
program rules and regulations and the client has not participated to such a degree that the
program's level of care is ineffective or unsafe for the client, despite multiple, documented
attempts that the license holder has made to address the client's lack of participation in
treatment;
 new text end

new text begin (2) the client has not made progress toward the client's treatment goals and objectives
despite the license holder's persistent efforts to engage the client in treatment, and the license
holder has no reasonable expectation that the client will make progress at the program's
level of care nor does the client require the program's level of care to maintain the current
level of functioning;
 new text end

new text begin (3) a court order or the client's legal status requires the client to participate in the program
but the client has left the program against staff person advice; or
 new text end

new text begin (4) the client meets criteria for a more intensive level of care and a more intensive level
of care is available to the client.
 new text end

new text begin (f) Prior to a program-initiated discharge of a client from a program, the license holder
must consult the client, the client's family and other natural supports, and the client's case
manager, if applicable, to review the issues involved in the program's decision to discharge
the client from the program. During the discharge review process, which must not exceed
five working days, the license holder must determine whether the license holder, treatment
team, and any interested persons can develop additional strategies to resolve the issues
leading to the client's discharge and to permit the client to have an opportunity to continue
receiving services from the license holder. The license holder may temporarily remove a
client from the program facility during the five-day discharge review period. The license
holder must document the client's discharge review in the client's file.
 new text end

new text begin (g) Prior to a program-initiated discharge of a client from the program, the license holder
must complete the client's discharge summary and provide the client with a copy of the
discharge summary in plain language that includes:
 new text end

new text begin (1) the reasons for the client's discharge;
 new text end

new text begin (2) the alternatives to discharge that the license holder considered or attempted to
implement;
 new text end

new text begin (3) the names of each individual who is involved in the decision to discharge the client
and a description of each individual's involvement; and
 new text end

new text begin (4) actions, supports, and services that the license holder recommends for the client to
successfully transition from the program to another setting.
 new text end

new text begin Subd. 19. new text end

new text begin Program facility. new text end

new text begin (a) The license holder must be licensed or certified as a
board and lodging facility, supervised living facility, or a boarding care home by the
Department of Health.
 new text end

new text begin (b) The license holder must have a capacity of five to 16 beds and the program must not
be declared as an institution for mental disease.
 new text end

new text begin (c) The license holder must furnish each program location to meet the psychological,
emotional, and developmental needs of clients.
 new text end

new text begin (d) The license holder must provide one living room or lounge area per program location.
There must be space available to provide services according to each client's treatment plan,
such as an area for learning recreation time skills and areas for learning independent living
skills, such as laundering clothes and preparing meals.
 new text end

new text begin (e) The license holder must ensure that each program location allows each client to have
privacy. Each client must have privacy during assessment interviews and counseling sessions.
Each client must have a space designated for the client to see outside visitors at the program
facility.
 new text end

new text begin Subd. 20. new text end

new text begin Physical separation of services. new text end

new text begin If the license holder offers services to
individuals who are not receiving intensive residential treatment services or residential
stabilization at the program location, the license holder must inform the commissioner and
submit a plan for approval to the commissioner about how and when the license holder will
provide services. The license holder must provide services to clients who are not receiving
intensive residential treatment services or residential crisis stabilization at the program
location. The license holder must only provide services to clients who are not receiving
intensive residential treatment services or residential crisis stabilization in an area that is
physically separated from the area in which the license holder provides clients with intensive
residential treatment services or residential crisis stabilization.
 new text end

new text begin Subd. 21. new text end

new text begin Dividing staff time between locations. new text end

new text begin A license holder must obtain approval
from the commissioner prior to providing intensive residential treatment services or
residential crisis stabilization to clients in more than one program location under one license
and dividing one staff person's time between program locations during the same work period.
 new text end

new text begin Subd. 22. new text end

new text begin Additional policy and procedure requirements. new text end

new text begin (a) In addition to the policies
and procedures in section 245I.03, the license holder must establish, enforce, and maintain
the policies and procedures in this subdivision.
 new text end

new text begin (b) The license holder must have policies and procedures for receiving referrals and
making admissions determinations about referred persons under subdivisions 14 to 16.
 new text end

new text begin (c) The license holder must have policies and procedures for discharging clients under
subdivision 17. In the policies and procedures, the license holder must identify the staff
persons who are authorized to discharge clients from the program.
 new text end

new text begin Subd. 23. new text end

new text begin Quality assurance and improvement plan. new text end

new text begin (a) A license holder must develop
a written quality assurance and improvement plan that includes a plan to:
 new text end

new text begin (1) encourage ongoing consultation between members of the treatment team;
 new text end

new text begin (2) obtain and evaluate feedback about services from clients, family and other natural
supports, referral sources, and staff persons;
 new text end

new text begin (3) measure and evaluate client outcomes in the program;
 new text end

new text begin (4) review critical incidents in the program;
 new text end

new text begin (5) examine the quality of clinical services in the program;
 new text end

new text begin (6) examine how efficiently the license holder uses resources; and
 new text end

new text begin (7) self-monitor the license holder's compliance with this chapter.
 new text end

new text begin (b) At least annually, the license holder must review, evaluate, and update the license
holder's quality assurance and improvement plan. The license holder's review must:
 new text end

new text begin (1) document the actions that the license holder will take in response to the information
that the license holder obtains from the monitoring activities in the plan; and
 new text end

new text begin (2) establish goals for improving the license holder's services to clients during the next
year.
 new text end

new text begin Subd. 24. new text end

new text begin Application. new text end

new text begin When an applicant requests licensure to provide intensive
residential treatment services, residential crisis stabilization, or both to clients, the applicant
must submit, on forms that the commissioner provides, any documents that the commissioner
requires.
 new text end

Sec. 17.

new text begin [256B.0671] COVERED MENTAL HEALTH SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) "Clinical trainee" means a staff person who is qualified
under section 245I.04, subdivision 6.
 new text end

new text begin (b) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
 new text end

new text begin (c) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
 new text end

new text begin Subd. 2. new text end

new text begin Generally. new text end

new text begin (a) An individual, organization, or government entity providing
mental health services to a client under this section must obtain a criminal background study
of each staff person or volunteer who is providing direct contact services to a client.
 new text end

new text begin (b) An individual, organization, or government entity providing mental health services
to a client under this section must comply with all responsibilities that chapter 245I assigns
to a license holder, except section 245I.011, subdivision 1, unless all of the individual's,
organization's, or government entity's treatment staff are qualified as mental health
professionals.
 new text end

new text begin (c) An individual, organization, or government entity providing mental health services
to a client under this section must comply with the following requirements if all of the
license holder's treatment staff are qualified as mental health professionals:
 new text end

new text begin (1) provider qualifications and scopes of practice under section 245I.04;
 new text end

new text begin (2) maintaining and updating personnel files under section 245I.07;
 new text end

new text begin (3) documenting under section 245I.08;
 new text end

new text begin (4) maintaining and updating client files under section 245I.09;
 new text end

new text begin (5) completing client assessments and treatment planning under section 245I.10;
 new text end

new text begin (6) providing clients with health services and medications under section 245I.11; and
 new text end

new text begin (7) respecting and enforcing client rights under section 245I.12.
 new text end

new text begin Subd. 3. new text end

new text begin Adult day treatment services. new text end

new text begin (a) Subject to federal approval, medical
assistance covers adult day treatment (ADT) services that are provided under contract with
the county board. Adult day treatment payment is subject to the conditions in paragraphs
(b) to (e). The provider must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments, protocols, and forms approved by
the commissioner.
 new text end

new text begin (b) Adult day treatment is an intensive psychotherapeutic treatment to reduce or relieve
the effects of mental illness on a client to enable the client to benefit from a lower level of
care and to live and function more independently in the community. Adult day treatment
services must be provided to a client to stabilize the client's mental health and to improve
the client's independent living and socialization skills. Adult day treatment must consist of
at least one hour of group psychotherapy and must include group time focused on
rehabilitative interventions or other therapeutic services that a multidisciplinary team provides
to each client. Adult day treatment services are not a part of inpatient or residential treatment
services. The following providers may apply to become adult day treatment providers:
 new text end

new text begin (1) a hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;
 new text end

new text begin (2) a community mental health center under section 256B.0625, subdivision 5; or
 new text end

new text begin (3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4712, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475.
 new text end

new text begin (c) An adult day treatment (ADT) services provider must:
 new text end

new text begin (1) ensure that the commissioner has approved of the organization as an adult day
treatment provider organization;
 new text end

new text begin (2) ensure that a multidisciplinary team provides ADT services to a group of clients. A
mental health professional must supervise each multidisciplinary staff person who provides
ADT services;
 new text end

new text begin (3) make ADT services available to the client at least two days a week for at least three
consecutive hours per day. ADT services may be longer than three hours per day, but medical
assistance may not reimburse a provider for more than 15 hours per week;
 new text end

new text begin (4) provide ADT services to each client that includes group psychotherapy by a mental
health professional or clinical trainee and daily rehabilitative interventions by a mental
health professional, clinical trainee, or mental health practitioner; and
 new text end

new text begin (5) include ADT services in the client's individual treatment plan, when appropriate.
The adult day treatment provider must:
 new text end

new text begin (i) complete a functional assessment of each client under section 245I.10, subdivision
9;
 new text end

new text begin (ii) notwithstanding section 245I.07, review the client's progress and update the individual
treatment plan at least every 90 days until the client is discharged from the program; and
 new text end

new text begin (iii) include a discharge plan for the client in the client's individual treatment plan.
 new text end

new text begin (d) To be eligible for adult day treatment, a client must:
 new text end

new text begin (1) be 18 years of age or older;
 new text end

new text begin (2) not reside in a nursing facility, hospital, institute of mental disease, or state-operated
treatment center unless the client has an active discharge plan that indicates a move to an
independent living setting within 180 days;
 new text end

new text begin (3) have the capacity to engage in rehabilitative programming, skills activities, and
psychotherapy in the structured, therapeutic setting of an adult day treatment program and
demonstrate measurable improvements in functioning resulting from participation in the
adult day treatment program;
 new text end

new text begin (4) have a level of care assessment under section 245I.02, subdivision 19, recommending
that the client participate in services with the level of intensity and duration of an adult day
treatment program; and
 new text end

new text begin (5) have the recommendation of a mental health professional for adult day treatment
services. The mental health professional must find that adult day treatment services are
medically necessary for the client.
 new text end

new text begin (e) Medical assistance does not cover the following services as adult day treatment
services:
 new text end

new text begin (1) services that are primarily recreational or that are provided in a setting that is not
under medical supervision, including sports activities, exercise groups, craft hours, leisure
time, social hours, meal or snack time, trips to community activities, and tours;
 new text end

new text begin (2) social or educational services that do not have or cannot reasonably be expected to
have a therapeutic outcome related to the client's mental illness;
 new text end

new text begin (3) consultations with other providers or service agency staff persons about the care or
progress of a client;
 new text end

new text begin (4) prevention or education programs that are provided to the community;
 new text end

new text begin (5) day treatment for clients with a primary diagnosis of a substance use disorder;
 new text end

new text begin (6) day treatment provided in the client's home;
 new text end

new text begin (7) psychotherapy for more than two hours per day; and
 new text end

new text begin (8) participation in meal preparation and eating that is not part of a clinical treatment
plan to address the client's eating disorder.
 new text end

new text begin Subd. 4. new text end

new text begin Explanation of findings. new text end

new text begin (a) Subject to federal approval, medical assistance
covers an explanation of findings that a mental health professional or clinical trainee provides
when the provider has obtained the authorization from the client or the client's representative
to release the information.
 new text end

new text begin (b) A mental health professional or clinical trainee provides an explanation of findings
to assist the client or related parties in understanding the results of the client's testing or
diagnostic assessment and the client's mental illness, and provides professional insight that
the client or related parties need to carry out a client's treatment plan. Related parties may
include the client's family and other natural supports and other service providers working
with the client.
 new text end

new text begin (c) An explanation of findings is not paid for separately when a mental health professional
or clinical trainee explains the results of psychological testing or a diagnostic assessment
to the client or the client's representative as part of the client's psychological testing or a
diagnostic assessment.
 new text end

new text begin Subd. 5. new text end

new text begin Family psychoeducation services. new text end

new text begin (a) Subject to federal approval, medical
assistance covers family psychoeducation services provided to a child up to age 21 with a
diagnosed mental health condition when identified in the child's individual treatment plan
and provided by a mental health professional or a clinical trainee who has determined it
medically necessary to involve family members in the child's care.
 new text end

new text begin (b) "Family psychoeducation services" means information or demonstration provided
to an individual or family as part of an individual, family, multifamily group, or peer group
session to explain, educate, and support the child and family 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.
 new text end

new text begin Subd. 6. new text end

new text begin Dialectical behavior therapy. new text end

new text begin (a) Subject to federal approval, medical assistance
covers intensive mental health outpatient treatment for dialectical behavior therapy for
adults. A dialectical behavior therapy provider must make reasonable and good faith efforts
to report individual client outcomes to the commissioner using instruments and protocols
that are approved by the commissioner.
 new text end

new text begin (b) "Dialectical behavior therapy" means an evidence-based treatment approach that a
mental health professional or clinical trainee provides to a client or a group of clients in an
intensive outpatient treatment program using a combination of individualized rehabilitative
and psychotherapeutic interventions. A dialectical behavior therapy program involves:
individual dialectical behavior therapy, group skills training, telephone coaching, and team
consultation meetings.
 new text end

new text begin (c) To be eligible for dialectical behavior therapy, a client must:
 new text end

new text begin (1) be 18 years of age or older;
 new text end

new text begin (2) have mental health needs that available community-based services cannot meet or
that the client must receive concurrently with other community-based services;
 new text end

new text begin (3) have either:
 new text end

new text begin (i) a diagnosis of borderline personality disorder; or
 new text end

new text begin (ii) multiple mental health diagnoses, exhibit behaviors characterized by impulsivity or
intentional self-harm, and be at significant risk of death, morbidity, disability, or severe
dysfunction in multiple areas of the client's life;
 new text end

new text begin (4) be cognitively capable of participating in dialectical behavior therapy as an intensive
therapy program and be able and willing to follow program policies and rules to ensure the
safety of the client and others; and
 new text end

new text begin (5) be at significant risk of one or more of the following if the client does not receive
dialectical behavior therapy:
 new text end

new text begin (i) having a mental health crisis;
 new text end

new text begin (ii) requiring a more restrictive setting such as hospitalization;
 new text end

new text begin (iii) decompensating; or
 new text end

new text begin (iv) engaging in intentional self-harm behavior.
 new text end

new text begin (d) Individual dialectical behavior therapy combines individualized rehabilitative and
psychotherapeutic interventions to treat a client's suicidal and other dysfunctional behaviors
and to reinforce a client's use of adaptive skillful behaviors. A mental health professional
or clinical trainee must provide individual dialectical behavior therapy to a client. A mental
health professional or clinical trainee providing dialectical behavior therapy to a client must:
 new text end

new text begin (1) identify, prioritize, and sequence the client's behavioral targets;
 new text end

new text begin (2) treat the client's behavioral targets;
 new text end

new text begin (3) assist the client in applying dialectical behavior therapy skills to the client's natural
environment through telephone coaching outside of treatment sessions;
 new text end

new text begin (4) measure the client's progress toward dialectical behavior therapy targets;
 new text end

new text begin (5) help the client manage mental health crises and life-threatening behaviors; and
 new text end

new text begin (6) help the client learn and apply effective behaviors when working with other treatment
providers.
 new text end

new text begin (e) Group skills training combines individualized psychotherapeutic and psychiatric
rehabilitative interventions conducted in a group setting to reduce the client's suicidal and
other dysfunctional coping behaviors and restore function. Group skills training must teach
the client adaptive skills in the following areas: (1) mindfulness; (2) interpersonal
effectiveness; (3) emotional regulation; and (4) distress tolerance.
 new text end

new text begin (f) Group skills training must be provided by two mental health professionals or by a
mental health professional co-facilitating with a clinical trainee or a mental health practitioner.
Individual skills training must be provided by a mental health professional, a clinical trainee,
or a mental health practitioner.
 new text end

new text begin (g) Before a program provides dialectical behavior therapy to a client, the commissioner
must certify the program as a dialectical behavior therapy provider. To qualify for
certification as a dialectical behavior therapy provider, a provider must:
 new text end

new text begin (1) allow the commissioner to inspect the provider's program;
 new text end

new text begin (2) provide evidence to the commissioner that the program's policies, procedures, and
practices meet the requirements of this subdivision and chapter 245I;
 new text end

new text begin (3) be enrolled as a MHCP provider; and
 new text end

new text begin (4) have a manual that outlines the program's policies, procedures, and practices that
meet the requirements of this subdivision.
 new text end

new text begin Subd. 7. new text end

new text begin Mental health clinical care consultation. new text end

new text begin (a) Subject to federal approval,
medical assistance covers clinical care consultation for a person up to age 21 who is
diagnosed with a complex mental health condition or a mental health condition that co-occurs
with other complex and chronic conditions, when described in the person's individual
treatment plan and provided by a mental health professional or a clinical trainee.
 new text end

new text begin (b) "Clinical care consultation" means communication from a treating mental health
professional to other providers or educators not under the treatment supervision of the
treating mental health professional who are 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 and to direct and
coordinate clinical service components provided to the client and family.
 new text end

new text begin Subd. 8. new text end

new text begin Neuropsychological assessment. new text end

new text begin (a) Subject to federal approval, medical
assistance covers a client's neuropsychological assessment.
 new text end

new text begin (b) Neuropsychological assessment" means a specialized clinical assessment of the
client's underlying cognitive abilities related to thinking, reasoning, and judgment that is
conducted by a qualified neuropsychologist. A neuropsychological assessment must include
a face-to-face interview with the client, interpretation of the test results, and preparation
and completion of a report.
 new text end

new text begin (c) A client is eligible for a neuropsychological assessment if the client meets at least
one of the following criteria:
 new text end

new text begin (1) the client has a known or strongly suspected brain disorder based on the client's
medical history or the client's prior neurological evaluation, including a history of significant
head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative
disorder, significant exposure to neurotoxins, central nervous system infection, metabolic
or toxic encephalopathy, fetal alcohol syndrome, or congenital malformation of the brain;
or
 new text end

new text begin (2) the client has cognitive or behavioral symptoms that suggest that the client has an
organic condition that cannot be readily attributed to functional psychopathology or suspected
neuropsychological impairment in addition to functional psychopathology. The client's
symptoms may include:
 new text end

new text begin (i) having a poor memory or impaired problem solving;
 new text end

new text begin (ii) experiencing change in mental status evidenced by lethargy, confusion, or
disorientation;
 new text end

new text begin (iii) experiencing a deteriorating level of functioning;
 new text end

new text begin (iv) displaying a marked change in behavior or personality;
 new text end

new text begin (v) in a child or an adolescent, having significant delays in acquiring academic skill or
poor attention relative to peers;
 new text end

new text begin (vi) in a child or an adolescent, having reached a significant plateau in expected
development of cognitive, social, emotional, or physical functioning relative to peers; and
 new text end

new text begin (vii) in a child or an adolescent, significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, emotional, or physical
demands.
 new text end

new text begin (d) The neuropsychological assessment must be completed by a neuropsychologist who:
 new text end

new text begin (1) was awarded a diploma by the American Board of Clinical Neuropsychology, the
American Board of Professional Neuropsychology, or the American Board of Pediatric
Neuropsychology;
 new text end

new text begin (2) earned a doctoral degree in psychology from an accredited university training program
and:
 new text end

new text begin (i) completed an internship or its equivalent in a clinically relevant area of professional
psychology;
 new text end

new text begin (ii) completed the equivalent of two full-time years of experience and specialized training,
at least one of which is at the postdoctoral level, supervised by a clinical neuropsychologist
in the study and practice of clinical neuropsychology and related neurosciences; and
 new text end

new text begin (iii) holds a current license to practice psychology independently according to sections
144.88 to 144.98;
 new text end

new text begin (3) is licensed or credentialed by another state's board of psychology examiners in the
specialty of neuropsychology using requirements equivalent to requirements specified by
one of the boards named in clause (1); or
 new text end

new text begin (4) was approved by the commissioner as an eligible provider of neuropsychological
assessments prior to December 31, 2010.
 new text end

new text begin Subd. 9. new text end

new text begin Neuropsychological testing. new text end

new text begin (a) Subject to federal approval, medical assistance
covers neuropsychological testing for clients.
 new text end

new text begin (b) "Neuropsychological testing" means administering standardized tests and measures
designed to evaluate the client's ability to attend to, process, interpret, comprehend,
communicate, learn, and recall information and use problem solving and judgment.
 new text end

new text begin (c) Medical assistance covers neuropsychological testing of a client when the client:
 new text end

new text begin (1) has a significant mental status change that is not a result of a metabolic disorder and
that has failed to respond to treatment;
 new text end

new text begin (2) is a child or adolescent with a significant plateau in expected development of
cognitive, social, emotional, or physical function relative to peers;
 new text end

new text begin (3) is a child or adolescent with a significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, physical, or emotional
demands; or
 new text end

new text begin (4) has a significant behavioral change, memory loss, or suspected neuropsychological
impairment in addition to functional psychopathology, or other organic brain injury or one
of the following:
 new text end

new text begin (i) traumatic brain injury;
 new text end

new text begin (ii) stroke;
 new text end

new text begin (iii) brain tumor;
 new text end

new text begin (iv) substance use disorder;
 new text end

new text begin (v) cerebral anoxic or hypoxic episode;
 new text end

new text begin (vi) central nervous system infection or other infectious disease;
 new text end

new text begin (vii) neoplasms or vascular injury of the central nervous system;
 new text end

new text begin (viii) neurodegenerative disorders;
 new text end

new text begin (ix) demyelinating disease;
 new text end

new text begin (x) extrapyramidal disease;
 new text end

new text begin (xi) exposure to systemic or intrathecal agents or cranial radiation known to be associated
with cerebral dysfunction;
 new text end

new text begin (xii) systemic medical conditions known to be associated with cerebral dysfunction,
including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and
related hematologic anomalies, and autoimmune disorders, including lupus, erythematosus,
or celiac disease;
 new text end

new text begin (xiii) congenital genetic or metabolic disorders known to be associated with cerebral
dysfunction, including phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
 new text end

new text begin (xiv) severe or prolonged nutrition or malabsorption syndromes; or
 new text end

new text begin (xv) a condition presenting in a manner difficult for a clinician to distinguish between
the neurocognitive effects of a neurogenic syndrome, including dementia or encephalopathy;
and a major depressive disorder when adequate treatment for major depressive disorder has
not improved the client's neurocognitive functioning; or another disorder, including autism,
selective mutism, anxiety disorder, or reactive attachment disorder.
 new text end

new text begin (d) Neuropsychological testing must be administered or clinically supervised by a
qualified neuropsychologist under subdivision 8, paragraph (c).
 new text end

new text begin (e) Medical assistance does not cover neuropsychological testing of a client when the
testing is:
 new text end

new text begin (1) primarily for educational purposes;
 new text end

new text begin (2) primarily for vocational counseling or training;
 new text end

new text begin (3) for personnel or employment testing;
 new text end

new text begin (4) a routine battery of psychological tests given to the client at the client's inpatient
admission or during a client's continued inpatient stay; or
 new text end

new text begin (5) for legal or forensic purposes.
 new text end

new text begin Subd. 10. new text end

new text begin Psychological testing. new text end

new text begin (a) Subject to federal approval, medical assistance
covers psychological testing of a client.
 new text end

new text begin (b) "Psychological testing" means the use of tests or other psychometric instruments to
determine the status of a client's mental, intellectual, and emotional functioning.
 new text end

new text begin (c) The psychological testing must:
 new text end

new text begin (1) be administered or supervised by a licensed psychologist qualified under section
245I.04, subdivision 2, clause (3), who is competent in the area of psychological testing;
and
 new text end

new text begin (2) be validated in a face-to-face interview between the client and a licensed psychologist
or a clinical trainee in psychology under the treatment supervision of a licensed psychologist
under section 245I.06.
 new text end

new text begin (d) A licensed psychologist must supervise the administration, scoring, and interpretation
of a client's psychological tests when a clinical psychology trainee, technician, psychometrist,
or psychological assistant or a computer-assisted psychological testing program completes
the psychological testing of the client. The report resulting from the psychological testing
must be signed by the licensed psychologist who conducts the face-to-face interview with
the client. The licensed psychologist or a staff person who is under treatment supervision
must place the client's psychological testing report in the client's record and release one
copy of the report to the client and additional copies to individuals authorized by the client
to receive the report.
 new text end

new text begin Subd. 11. new text end

new text begin Psychotherapy. new text end

new text begin (a) Subject to federal approval, medical assistance covers
psychotherapy for a client.
 new text end

new text begin (b) "Psychotherapy" means treatment of a client with mental illness that applies to the
most appropriate psychological, psychiatric, psychosocial, or interpersonal method that
conforms to prevailing community standards of professional practice to meet the mental
health needs of the client. Medical assistance covers psychotherapy if a mental health
professional or a clinical trainee provides psychotherapy to a client.
 new text end

new text begin (c) "Individual psychotherapy" means psychotherapy that a mental health professional
or clinical trainee designs for a client.
 new text end

new text begin (d) "Family psychotherapy" means psychotherapy that a mental health professional or
clinical trainee designs for a client and one or more and the client's family members or
primary caregiver whose participation is necessary to accomplish the client's treatment
goals. Family members or primary caregivers participating in a therapy session do not need
to be eligible for medical assistance for medical assistance to cover family psychotherapy.
For purposes of this paragraph, "primary caregiver whose participation is necessary to
accomplish the client's treatment goals" excludes shift or facility staff persons who work at
the client's residence. Medical assistance payments for family psychotherapy are limited to
face-to-face sessions during which the client is present throughout the session, unless the
mental health professional or clinical trainee believes that the client's exclusion from the
family psychotherapy session is necessary to meet the goals of the client's individual
treatment plan. If the client is excluded from a family psychotherapy session, a mental health
professional or clinical trainee must document the reason for the client's exclusion and the
length of time that the client is excluded. The mental health professional must also document
any reason that a member of the client's family is excluded from a psychotherapy session.
 new text end

new text begin (e) Group psychotherapy is appropriate for a client who, because of the nature of the
client's emotional, behavioral, or social dysfunctions, can benefit from treatment in a group
setting. For a group of three to eight clients, at least one mental health professional or clinical
trainee must provide psychotherapy to the group. For a group of nine to 12 clients, a team
of at least two mental health professionals or two clinical trainees or one mental health
professional and one clinical trainee must provide psychotherapy to the group. Medical
assistance will cover group psychotherapy for a group of no more than 12 persons.
 new text end

new text begin (f) A multiple-family group psychotherapy session is eligible for medical assistance if
a mental health professional or clinical trainee designs the psychotherapy session for at least
two but not more than five families. A mental health professional or clinical trainee must
design multiple-family group psychotherapy sessions to meet the treatment needs of each
client. If the client is excluded from a psychotherapy session, the mental health professional
or clinical trainee must document the reason for the client's exclusion and the length of time
that the client was excluded. The mental health professional or clinical trainee must document
any reason that a member of the client's family was excluded from a psychotherapy session.
 new text end

new text begin Subd. 12. new text end

new text begin Partial hospitalization. new text end

new text begin (a) Subject to federal approval, medical assistance
covers a client's partial hospitalization.
 new text end

new text begin (b) "Partial hospitalization" means a provider's time-limited, structured program of
psychotherapy and other therapeutic services, as defined in United States Code, title 42,
chapter 7, subchapter XVIII, part E, section 1395x(ff), that a multidisciplinary staff person
provides in an outpatient hospital facility or community mental health center that meets
Medicare requirements to provide partial hospitalization services to a client.
 new text end

new text begin (c) Partial hospitalization is an appropriate alternative to inpatient hospitalization for a
client who is experiencing an acute episode of mental illness who meets the criteria for an
inpatient hospital admission under Minnesota Rules, part 9505.0520, subpart 1, and who
has family and community resources that support the client's residence in the community.
Partial hospitalization consists of multiple intensive short-term therapeutic services for a
client that a multidisciplinary staff person provides to a client to treat the client's mental
illness.
 new text end

new text begin Subd. 13. new text end

new text begin Diagnostic assessments. new text end

new text begin Subject to federal approval, medical assistance covers
a client's diagnostic assessments that a mental health professional or clinical trainee completes
under section 245I.10.
 new text end

Sec. 18. new text begin DIRECTION TO COMMISSIONER; SINGLE COMPREHENSIVE
LICENSE STRUCTURE.
new text end

new text begin The commissioner of human services, in consultation with stakeholders including
counties, tribes, managed care organizations, provider organizations, advocacy groups, and
clients and clients' families, shall develop recommendations to develop a single
comprehensive licensing structure for mental health service programs, including outpatient
and residential services for adults and children. The recommendations must prioritize
program integrity, the welfare of clients and clients' families, improved integration of mental
health and substance use disorder services, and the reduction of administrative burden on
providers.
 new text end

ARTICLE 8

MENTAL HEALTH UNIFORM SERVICE STANDARDS: CRISIS SERVICES

Section 1.

Minnesota Statutes 2020, section 245.469, subdivision 1, is amended to read:


Subdivision 1.

Availability of emergency services.

deleted text begin By July 1, 1988,deleted text end County boards
must provide or contract for enough emergency services within the county to meet the needs
of adultsnew text begin , children, and familiesnew text end in the county who are experiencing an emotional crisis or
mental illness. Clients may be required to pay a fee according to section 245.481. new text begin Emergency
service providers must not delay the timely provision of emergency services to a client
because of delays in determining the fee under section 245.481 or because of the
unwillingness or inability of the client to pay the fee. new text end Emergency services must include
assessment, crisis intervention, and appropriate case disposition. Emergency services must:

(1) promote the safety and emotional stability of deleted text begin adults with mental illness or emotional
crisesdeleted text end new text begin each clientnew text end ;

(2) minimize further deterioration of deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each
clientnew text end ;

(3) help deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each clientnew text end to obtain ongoing care
and treatment; deleted text begin and
deleted text end

(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needsdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (5) provide support, psychoeducation, and referrals to each client's family members,
service providers, and other third parties on behalf of the client in need of emergency
services.
 new text end

Sec. 2.

Minnesota Statutes 2020, section 245.469, subdivision 2, is amended to read:


Subd. 2.

Specific requirements.

(a) The county board shall require that all service
providers of emergency services to adults with mental illness provide immediate direct
access to a mental health professional during regular business hours. For evenings, weekends,
and holidays, the service may be by direct toll-free telephone access to a mental health
professional, deleted text begin adeleted text end new text begin clinical trainee, ornew text end mental health practitionerdeleted text begin , or until January 1, 1991, a
designated person with training in human services who receives clinical supervision from
a mental health professionaldeleted text end .

(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:

(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;

(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and

(3) the service provider is not also the provider of fire and public safety emergency
services.

(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:

(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services deleted text begin reviewed by the state advisory
council on mental health and thendeleted text end approved by the commissioner;

(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services deleted text begin reviewed by
the state advisory council on mental health and thendeleted text end approved by the commissioner;

(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;

(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls received;

(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and

(6) the local social service agency describes how it will comply with paragraph (d).

(d) Whenever emergency service during nonbusiness hours is provided by anyone other
than a mental health professional, a mental health professional must be available on call for
an emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.

Sec. 3.

Minnesota Statutes 2020, section 245.4879, subdivision 1, is amended to read:


Subdivision 1.

Availability of emergency services.

County boards must provide or
contract for deleted text begin enoughdeleted text end mental health emergency services deleted text begin within the county to meet the needs
of children, and children's families when clinically appropriate, in the county who are
experiencing an emotional crisis or emotional disturbance. The county board shall ensure
that parents, providers, and county residents are informed about when and how to access
emergency mental health services for children. A child or the child's parent may be required
to pay a fee according to section 245.481. Emergency service providers shall not delay the
timely provision of emergency service because of delays in determining this fee or because
of the unwillingness or inability of the parent to pay the fee. Emergency services must
include assessment, crisis intervention, and appropriate case disposition. Emergency services
must:deleted text end new text begin according to section 245.469.
new text end

deleted text begin (1) promote the safety and emotional stability of children with emotional disturbances
or emotional crises;
 deleted text end

deleted text begin (2) minimize further deterioration of the child with emotional disturbance or emotional
crisis;
 deleted text end

deleted text begin (3) help each child with an emotional disturbance or emotional crisis to obtain ongoing
care and treatment; and
 deleted text end

deleted text begin (4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet the child's needs.
 deleted text end

Sec. 4.

Minnesota Statutes 2020, section 256B.0624, is amended to read:


256B.0624 deleted text begin ADULTdeleted text end CRISIS RESPONSE SERVICES COVERED.

Subdivision 1.

Scope.

deleted text begin Medical assistance covers adult mental health crisis response
services as defined in subdivision 2, paragraphs (c) to (e),deleted text end new text begin (a) new text end Subject to federal approval,
deleted text begin if provided to a recipient as defined in subdivision 3 and provided by a qualified provider
entity as defined in this section and by a qualified individual provider working within the
provider's scope of practice and as defined in this subdivision and identified in the recipient's
individual crisis treatment plan as defined in subdivision 11 and if determined to be medically
necessarydeleted text end new text begin medical assistance covers medically necessary crisis response services when the
services are provided according to the standards in this sectionnew text end .

new text begin (b) Subject to federal approval, medical assistance covers medically necessary residential
crisis stabilization when the services are provided by an entity licensed under and meeting
the standards in section 245I.23.
 new text end

new text begin (c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments and protocols approved by the
commissioner.
 new text end

Subd. 2.

Definitions.

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

deleted text begin (a) "Mental health crisis" is an adult behavioral, emotional, or psychiatric situation
which, but for the provision of crisis response services, would likely result in significantly
reduced levels of functioning in primary activities of daily living, or in an emergency
situation, or in the placement of the recipient in a more restrictive setting, including, but
not limited to, inpatient hospitalization.
 deleted text end

deleted text begin (b) "Mental health emergency" is an adult behavioral, emotional, or psychiatric situation
which causes an immediate need for mental health services and is consistent with section
62Q.55.
 deleted text end

deleted text begin A mental health crisis or emergency is determined for medical assistance service
reimbursement by a physician, a mental health professional, or crisis mental health
practitioner with input from the recipient whenever possible.
 deleted text end

new text begin (a) "Certified rehabilitation specialist" means a staff person who is qualified under section
245I.04, subdivision 8.
 new text end

new text begin (b) "Clinical trainee" means a staff person who is qualified under section 245I.04,
subdivision 6.
 new text end

(c) "deleted text begin Mental healthdeleted text end Crisis assessment" means an immediate face-to-face assessment by
a physician, a mental health professional, or deleted text begin mental health practitioner under the clinical
supervision of a mental health professional, following a screening that suggests that the
adult may be experiencing a mental health crisis or mental health emergency situation. It
includes, when feasible, assessing whether the person might be willing to voluntarily accept
treatment, determining whether the person has an advance directive, and obtaining
information and history from involved family members or caretakersdeleted text end new text begin a qualified member
of a crisis team, as described in subdivision 6anew text end .

(d) "deleted text begin Mental health mobiledeleted text end Crisis intervention deleted text begin servicesdeleted text end " means face-to-face, short-term
intensive mental health services initiated during a mental health crisis deleted text begin or mental health
emergencydeleted text end to help the recipient cope with immediate stressors, identify and utilize available
resources and strengths, engage in voluntary treatment, and begin to return to the recipient's
baseline level of functioning. deleted text begin The services, including screening and treatment plan
recommendations, must be culturally and linguistically appropriate.
deleted text end

deleted text begin (1) This service is provided on site by a mobile crisis intervention team outside of an
inpatient hospital setting. Mental health mobile crisis intervention services must be available
24 hours a day, seven days a week.
 deleted text end

deleted text begin (2) The initial screening must consider other available services to determine which
service intervention would best address the recipient's needs and circumstances.
 deleted text end

deleted text begin (3) The mobile crisis intervention team must be available to meet promptly face-to-face
with a person in mental health crisis or emergency in a community setting or hospital
emergency room.
 deleted text end

deleted text begin (4) The intervention must consist of a mental health crisis assessment and a crisis
treatment plan.
 deleted text end

deleted text begin (5) The team must be available to individuals who are experiencing a co-occurring
substance use disorder, who do not need the level of care provided in a detoxification facility.
 deleted text end

deleted text begin (6) The treatment plan must include recommendations for any needed crisis stabilization
services for the recipient, including engagement in treatment planning and family
psychoeducation.
 deleted text end

new text begin (e) "Crisis screening" means a screening of a client's potential mental health crisis
situation under subdivision 6.
 new text end

deleted text begin (e)deleted text end new text begin (f)new text end "deleted text begin Mental healthdeleted text end Crisis stabilization deleted text begin servicesdeleted text end " means individualized mental health
services provided to a recipient deleted text begin following crisis intervention servicesdeleted text end which are designed
to restore the recipient to the recipient's prior functional level. deleted text begin Mental healthdeleted text end Crisis
stabilization services may be provided in the recipient's home, the home of a family member
or friend of the recipient, another community setting, or a short-term supervised, licensed
residential program. deleted text begin Mental health crisis stabilization does not include partial hospitalization
or day treatment. Mental healthdeleted text end Crisis stabilization services includes family psychoeducation.

new text begin (g) "Crisis team" means the staff of a provider entity who are supervised and prepared
to provide mobile crisis services to a client in a potential mental health crisis situation.
 new text end

new text begin (h) "Mental health certified family peer specialist" means a staff person who is qualified
under section 245I.04, subdivision 12.
 new text end

new text begin (i) "Mental health certified peer specialist" means a staff person who is qualified under
section 245I.04, subdivision 10.
 new text end

new text begin (j) "Mental health crisis" is a behavioral, emotional, or psychiatric situation that, without
the provision of crisis response services, would likely result in significantly reducing the
recipient's levels of functioning in primary activities of daily living, in an emergency situation
under section 62Q.55, or in the placement of the recipient in a more restrictive setting,
including but not limited to inpatient hospitalization.
 new text end

new text begin (k) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
 new text end

new text begin (l) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
 new text end

new text begin (m) "Mental health rehabilitation worker" means a staff person who is qualified under
section 245I.04, subdivision 14.
 new text end

new text begin (n) "Mobile crisis services" means screening, assessment, intervention, and community
based stabilization, excluding residential crisis stabilization, that is provided to a recipient.
 new text end

Subd. 3.

Eligibility.

deleted text begin An eligible recipient is an individual who:
 deleted text end

deleted text begin (1) is age 18 or older;
 deleted text end

deleted text begin (2) is screened as possibly experiencing a mental health crisis or emergency where a
mental health crisis assessment is needed; and
 deleted text end

deleted text begin (3) is assessed as experiencing a mental health crisis or emergency, and mental health
crisis intervention or crisis intervention and stabilization services are determined to be
medically necessary.
 deleted text end

new text begin (a) A recipient is eligible for crisis assessment services when the recipient has screened
positive for a potential mental health crisis during a crisis screening.
 new text end

new text begin (b) A recipient is eligible for crisis intervention services and crisis stabilization services
when the recipient has been assessed during a crisis assessment to be experiencing a mental
health crisis.
 new text end

Subd. 4.

Provider entity standards.

(a) A deleted text begin provider entity is an entity that meets the
standards listed in paragraph (c) anddeleted text end new text begin mobile crisis provider must benew text end :

(1) deleted text begin isdeleted text end a county board operated entity; deleted text begin or
deleted text end

new text begin (2) an Indian health services facility or facility owned and operated by a tribe or tribal
organization operating under United States Code, title 325, section 450f; or
 new text end

deleted text begin (2) isdeleted text end new text begin (3)new text end a provider entity that is under contract with the county board in the county
where the potential crisis or emergency is occurring. To provide services under this section,
the provider entity must directly provide the services; or if services are subcontracted, the
provider entity must maintain responsibility for services and billing.

new text begin (b) A mobile crisis provider must meet the following standards:
 new text end

new text begin (1) must ensure that crisis screenings, crisis assessments, and crisis intervention services
are available to a recipient 24 hours a day, seven days a week;
 new text end

new text begin (2) must be able to respond to a call for services in a designated service area or according
to a written agreement with the local mental health authority for an adjacent area;
 new text end

new text begin (3) must have at least one mental health professional on staff at all times and at least
one additional staff member capable of leading a crisis response in the community; and
 new text end

new text begin (4) must provide the commissioner with information about the number of requests for
service, the number of people that the provider serves face-to-face, outcomes, and the
protocols that the provider uses when deciding when to respond in the community.
 new text end

deleted text begin (b)deleted text end new text begin (c)new text end A provider entity that provides crisis stabilization services in a residential setting
under subdivision 7 is not required to meet the requirements of deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (a)deleted text begin ,
clauses (1) and (2)deleted text end new text begin to (b)new text end , but must meet all other requirements of this subdivision.

deleted text begin (c) The adult mental healthdeleted text end new text begin (d) Anew text end crisis deleted text begin responsedeleted text end services provider deleted text begin entitydeleted text end must have the
capacity to meet and carry out the new text begin standards in section 245I.011, subdivision 5, and the
new text end following standards:

(1) deleted text begin has the capacity to recruit, hire, and manage and train mental health professionals,
practitioners, and rehabilitation workersdeleted text end new text begin ensures that staff persons provide support for a
recipient's family and natural supports, by enabling the recipient's family and natural supports
to observe and participate in the recipient's treatment, assessments, and planning servicesnew text end ;

(2) has adequate administrative ability to ensure availability of services;

deleted text begin (3) is able to ensure adequate preservice and in-service training;
 deleted text end

deleted text begin (4)deleted text end new text begin (3)new text end is able to ensure that staff providing these services are skilled in the delivery of
mental health crisis response services to recipients;

deleted text begin (5)deleted text end new text begin (4)new text end is able to ensure that staff are deleted text begin capable ofdeleted text end implementing culturally specific treatment
identified in the deleted text begin individualdeleted text end new text begin crisisnew text end treatment plan that is meaningful and appropriate as
determined by the recipient's culture, beliefs, values, and language;

deleted text begin (6)deleted text end new text begin (5)new text end is able to ensure enough flexibility to respond to the changing intervention and
care needs of a recipient as identified by the recipient during the service partnership between
the recipient and providers;

deleted text begin (7)deleted text end new text begin (6)new text end is able to ensure that deleted text begin mental health professionals and mental health practitionersdeleted text end new text begin
staffnew text end have the communication tools and procedures to communicate and consult promptly
about crisis assessment and interventions as services occur;

deleted text begin (8)deleted text end new text begin (7)new text end is able to coordinate these services with county emergency services, community
hospitals, ambulance, transportation services, social services, law enforcement, and mental
health crisis services through regularly scheduled interagency meetings;

deleted text begin (9) is able to ensure that mental health crisis assessment and mobile crisis intervention
services are available 24 hours a day, seven days a week;
 deleted text end

deleted text begin (10)deleted text end new text begin (8)new text end is able to ensure that services are coordinated with other deleted text begin mentaldeleted text end new text begin behavioralnew text end
health service providers, county mental health authorities, or federally recognized American
Indian authorities and others as necessary, with the consent of the deleted text begin adultdeleted text end new text begin recipientnew text end . Services
must also be coordinated with the recipient's case manager if the deleted text begin adultdeleted text end new text begin recipientnew text end is receiving
case management services;

deleted text begin (11)deleted text end new text begin (9)new text end is able to ensure that crisis intervention services are provided in a manner
consistent with sections 245.461 to 245.486new text begin and 245.487 to 245.4879new text end ;

deleted text begin (12) is able to submit information as required by the state;
 deleted text end

deleted text begin (13) maintains staff training and personnel files;
 deleted text end

new text begin (10) is able to coordinate detoxification services for the recipient according to Minnesota
Rules, parts 9530.6605 to 9530.6655, or withdrawal management according to chapter 245F;
 new text end

deleted text begin (14)deleted text end new text begin (11)new text end is able to establish and maintain a quality assurance and evaluation plan to
evaluate the outcomes of services and recipient satisfaction;new text begin and
new text end

deleted text begin (15) is able to keep records as required by applicable laws;
 deleted text end

deleted text begin (16) is able to comply with all applicable laws and statutes;
 deleted text end

deleted text begin (17)deleted text end new text begin (12)new text end is an enrolled medical assistance providerdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (18) develops and maintains written policies and procedures regarding service provision
and administration of the provider entity, including safety of staff and recipients in high-risk
situations.
 deleted text end

Subd. 4a.

Alternative provider standards.

If a county new text begin or tribe new text end demonstrates that, due
to geographic or other barriers, it is not feasible to provide mobile crisis intervention services
according to the standards in subdivision 4, paragraph deleted text begin (c), clause (9)deleted text end new text begin (b)new text end , the commissioner
may approve deleted text begin a crisis response provider based ondeleted text end an alternative plan proposed by a county
or deleted text begin group of countiesdeleted text end new text begin tribenew text end . The alternative plan must:

(1) result in increased access and a reduction in disparities in the availability of new text begin mobile
new text end crisis services;

(2) provide mobile new text begin crisis new text end services outside of the usual nine-to-five office hours and on
weekends and holidays; and

(3) comply with standards for emergency mental health services in section 245.469.

Subd. 5.

deleted text begin Mobiledeleted text end Crisis new text begin assessment and new text end intervention staff qualifications.

deleted text begin For provision
of adult mental health mobile crisis intervention services, a mobile crisis intervention team
is comprised of at least two mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6), or a combination of at least one mental health professional
and one mental health practitioner as defined in section 245.462, subdivision 17, with the
required mental health crisis training and under the clinical supervision of a mental health
professional on the team. The team must have at least two people with at least one member
providing on-site crisis intervention services when needed.deleted text end new text begin (a) Qualified individual staff of
a qualified provider entity must provide crisis assessment and intervention services to a
recipient. A staff member providing crisis assessment and intervention services to a recipient
must be qualified as a:
new text end

new text begin (1) mental health professional;
 new text end

new text begin (2) clinical trainee;
 new text end

new text begin (3) mental health practitioner;
 new text end

new text begin (4) mental health certified family peer specialist; or
 new text end

new text begin (5) mental health certified peer specialist.
 new text end

new text begin (b) When crisis assessment and intervention services are provided to a recipient in the
community, a mental health professional, clinical trainee, or mental health practitioner must
lead the response.
 new text end

new text begin (c) The 30 hours of ongoing training required by section 245I.05, subdivision 4, paragraph
(b), must be specific to providing crisis services to a recipient and include training about
evidence-based practices identified by the commissioner of health to reduce the recipient's
risk of suicide and self-injurious behavior.
 new text end

new text begin (d) new text end Team members must be experienced in deleted text begin mental healthdeleted text end new text begin crisisnew text end assessment, crisis
intervention techniques, treatment engagement strategies, working with families, and clinical
decision-making under emergency conditions and have knowledge of local services and
resources. deleted text begin The team must recommend and coordinate the team's services with appropriate
local resources such as the county social services agency, mental health services, and local
law enforcement when necessary.
deleted text end

Subd. 6.

Crisis deleted text begin assessment and mobile intervention treatment planningdeleted text end new text begin screeningnew text end .

(a)
deleted text begin Prior to initiating mobile crisis intervention services, a screening of the potential crisis
situation must be conducted.deleted text end The new text begin crisis new text end screening may use the resources of deleted text begin crisis assistance
anddeleted text end emergency services as defined in deleted text begin sections 245.462, subdivision 6, anddeleted text end new text begin sectionnew text end 245.469,
subdivisions 1 and 2. The new text begin crisis new text end screening must gather information, determine whether a
new text begin mental health new text end crisis situation exists, identify parties involved, and determine an appropriate
response.

new text begin (b) When conducting the crisis screening of a recipient, a provider must:
 new text end

new text begin (1) employ evidence-based practices to reduce the recipient's risk of suicide and
self-injurious behavior;
 new text end

new text begin (2) work with the recipient to establish a plan and time frame for responding to the
recipient's mental health crisis, including responding to the recipient's immediate need for
support by telephone or text message until the provider can respond to the recipient
face-to-face;
 new text end

new text begin (3) document significant factors in determining whether the recipient is experiencing a
mental health crisis, including prior requests for crisis services, a recipient's recent
presentation at an emergency department, known calls to 911 or law enforcement, or
information from third parties with knowledge of a recipient's history or current needs;
 new text end

new text begin (4) accept calls from interested third parties and consider the additional needs or potential
mental health crises that the third parties may be experiencing;
 new text end

new text begin (5) provide psychoeducation, including means reduction, to relevant third parties
including family members or other persons living with the recipient; and
 new text end

new text begin (6) consider other available services to determine which service intervention would best
address the recipient's needs and circumstances.
 new text end

new text begin (c) For the purposes of this section, the following situations indicate a positive screen
for a potential mental health crisis and the provider must prioritize providing a face-to-face
crisis assessment of the recipient, unless a provider documents specific evidence to show
why this was not possible, including insufficient staffing resources, concerns for staff or
recipient safety, or other clinical factors:
 new text end

new text begin (1) the recipient presents at an emergency department or urgent care setting and the
health care team at that location requested crisis services; or
 new text end

new text begin (2) a peace officer requested crisis services for a recipient who is potentially subject to
transportation under section 253B.051.
 new text end

new text begin (d) A provider is not required to have direct contact with the recipient to determine that
the recipient is experiencing a potential mental health crisis. A mobile crisis provider may
gather relevant information about the recipient from a third party at the scene to establish
the recipient's need for services and potential safety factors.
 new text end

new text begin Subd. 6a. new text end

new text begin Crisis assessment. new text end

deleted text begin (b)deleted text end new text begin (a)new text end If a deleted text begin crisis existsdeleted text end new text begin recipient screens positive for
potential mental health crisisnew text end , a crisis assessment must be completed. A crisis assessment
evaluates any immediate needs for which deleted text begin emergencydeleted text end services are needed and, as time
permits, the recipient's current life situation, new text begin health information, including current
medications, new text end sources of stress, mental health problems and symptoms, strengths, cultural
considerations, support network, vulnerabilities, current functioning, and the recipient's
preferences as communicated directly by the recipient, or as communicated in a health care
directive as described in chapters 145C and 253B, the new text begin crisis new text end treatment plan described under
deleted text begin paragraph (d)deleted text end new text begin subdivision 11new text end , a crisis prevention plan, or a wellness recovery action plan.

new text begin (b) A provider must conduct a crisis assessment at the recipient's location whenever
possible.
 new text end

new text begin (c) Whenever possible, the assessor must attempt to include input from the recipient and
the recipient's family and other natural supports to assess whether a crisis exists.
 new text end

new text begin (d) A crisis assessment includes determining: (1) whether the recipient is willing to
voluntarily engage in treatment or (2) has an advance directive and (3) gathering the
recipient's information and history from involved family or other natural supports.
 new text end

new text begin (e) A crisis assessment must include coordinated response with other health care providers
if the assessment indicates that a recipient needs detoxification, withdrawal management,
or medical stabilization in addition to crisis response services. If the recipient does not need
an acute level of care, a team must serve an otherwise eligible recipient who has a
co-occurring substance use disorder.
 new text end

new text begin (f) If, after completing a crisis assessment of a recipient, a provider refers a recipient to
an intensive setting, including an emergency department, inpatient hospitalization, or
residential crisis stabilization, one of the crisis team members who completed or conferred
about the recipient's crisis assessment must immediately contact the referral entity and
consult with the triage nurse or other staff responsible for intake at the referral entity. During
the consultation, the crisis team member must convey key findings or concerns that led to
the recipient's referral. Following the immediate consultation, the provider must also send
written documentation upon completion. The provider must document if these releases
occurred with authorization by the recipient, the recipient's legal guardian, or as allowed
by section 144.293, subdivision 5.
 new text end

new text begin Subd. 6b. new text end

new text begin Crisis intervention services. new text end

deleted text begin (c)deleted text end new text begin (a)new text end If the crisis assessment determines mobile
crisis intervention services are needed, the new text begin crisis new text end intervention services must be provided
promptly. As opportunity presents during the intervention, at least two members of the
mobile crisis intervention team must confer directly or by telephone about the new text begin crisis
new text end assessment, new text begin crisis new text end treatment plan, and actions taken and needed. At least one of the team
members must be deleted text begin on sitedeleted text end providing new text begin face-to-face new text end crisis intervention services. If providing
deleted text begin on-sitedeleted text end crisis intervention services, a new text begin clinical trainee or new text end mental health practitioner must seek
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision as required in subdivision 9.

new text begin (b) If a provider delivers crisis intervention services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
 new text end

deleted text begin (d)deleted text end new text begin (c)new text end The mobile crisis intervention team must develop deleted text begin an initial, briefdeleted text end new text begin anew text end crisis treatment
plan deleted text begin as soon as appropriate but no later than 24 hours after the initial face-to-face interventiondeleted text end new text begin
according to subdivision 11new text end . deleted text begin The plan must address the needs and problems noted in the
crisis assessment and include deleted text end deleted text begin measurable short-term goals, cultural considerations, and
frequency and type of services to be provided to achieve the goals and reduce or eliminate
the crisis. The treatment plan must be updated as needed to reflect current goals and services.
deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end The new text begin mobile crisis intervention new text end team must document which deleted text begin short-term goalsdeleted text end new text begin crisis
treatment plan goals and objectivesnew text end have been met and when no further crisis intervention
services are required.

deleted text begin (f)deleted text end new text begin (e)new text end If the recipient's new text begin mental health new text end crisis is stabilized, but the recipient needs a referral
to other services, the team must provide referrals to these services. If the recipient has a
case manager, planning for other services must be coordinated with the case manager. If
the recipient is unable to follow up on the referral, the team must link the recipient to the
service and follow up to ensure the recipient is receiving the service.

deleted text begin (g)deleted text end new text begin (f)new text end If the recipient's new text begin mental health new text end crisis is stabilized and the recipient does not have
an advance directive, the case manager or crisis team shall offer to work with the recipient
to develop one.

Subd. 7.

Crisis stabilization services.

(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:

(1) a crisis deleted text begin stabilizationdeleted text end treatment plan must be developed deleted text begin whichdeleted text end new text begin thatnew text end meets the criteria
in subdivision 11;

(2) staff must be qualified as defined in subdivision 8; deleted text begin and
deleted text end

(3) new text begin crisis stabilization new text end services must be delivered according to the new text begin crisis new text end treatment plan
and include face-to-face contact with the recipient by qualified staff for further assessment,
help with referrals, updating of the crisis deleted text begin stabilizationdeleted text end treatment plan, deleted text begin supportive counseling,deleted text end
skills training, and collaboration with other service providers in the communitydeleted text begin .deleted text end new text begin ; and
new text end

new text begin (4) if a provider delivers crisis stabilization services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
 new text end

deleted text begin (b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end If crisis stabilization services are provided in a supervised, licensed residential
setting that serves no more than four adult residents, and one or more individuals are present
at the setting to receive residential crisis stabilization deleted text begin servicesdeleted text end , the residential staff must
include, for at least eight hours per day, at least one deleted text begin individual who meets the qualifications
in subdivision 8, paragraph (a), clause (1) or (2)deleted text end new text begin mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end .

deleted text begin (d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. During the first 48 hours that a recipient is in the
residential program, the residential program must have at least two staff working 24 hours
a day. Staffing levels may be adjusted thereafter according to the needs of the recipient as
specified in the crisis stabilization treatment plan.
 deleted text end

Subd. 8.

deleted text begin Adultdeleted text end Crisis stabilization staff qualifications.

(a) deleted text begin Adultdeleted text end Mental health crisis
stabilization services must be provided by qualified individual staff of a qualified provider
entity. deleted text begin Individual provider staff must have the following qualificationsdeleted text end new text begin A staff member
providing crisis stabilization services to a recipient must be qualified as anew text end :

(1) deleted text begin be adeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end ;

(2) deleted text begin be adeleted text end new text begin certified rehabilitation specialist;
new text end

new text begin (3) clinical trainee;
 new text end

new text begin (4)new text end mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end ;

new text begin (5) mental health certified family peer specialist;
 new text end

deleted text begin (3) be adeleted text end new text begin (6) mental healthnew text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end ; or

deleted text begin (4) be adeleted text end new text begin (7)new text end mental health rehabilitation worker deleted text begin who meets the criteria in section
256B.0623, subdivision 5, paragraph (a), clause (4); works under the direction of a mental
health practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professionaldeleted text end .

(b) deleted text begin Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during the
past two years.deleted text end new text begin The 30 hours of ongoing training required in section 245I.05, subdivision
4, paragraph (b), must be specific to providing crisis services to a recipient and include
training about evidence-based practices identified by the commissioner of health to reduce
a recipient's risk of suicide and self-injurious behavior.
new text end

Subd. 9.

Supervision.

new text begin Clinical trainees and new text end mental health practitioners may provide
crisis assessment and deleted text begin mobiledeleted text end crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:

(1) the mental health provider entity must accept full responsibility for the services
provided;

(2) the mental health professional of the provider entitydeleted text begin , who is an employee or under
contract with the provider entity,deleted text end must be immediately available by phone or in person for
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision;

(3) the mental health professional is consulted, in person or by phone, during the first
three hours when a new text begin clinical trainee or new text end mental health practitioner provides deleted text begin on-site servicedeleted text end new text begin
crisis assessment or crisis intervention servicesnew text end ;new text begin and
new text end

(4) the mental health professional must:

(i) review and approvenew text begin , as defined in section 245I.02, subdivision 2,new text end of the tentative
crisis assessment and crisis treatment plannew text begin within 24 hours of first providing services to the
recipient, notwithstanding section 245I.08, subdivision 3new text end ;new text begin and
new text end

(ii) document the consultationnew text begin required in clause (3).new text end deleted text begin ; and
deleted text end

deleted text begin (iii) sign the crisis assessment and treatment plan within the next business day;
 deleted text end

deleted text begin (5) if the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the recipient face-to-face on the second day to provide
services and update the crisis treatment plan; and
 deleted text end

deleted text begin (6) the on-site observation must be documented in the recipient's record and signed by
the mental health professional.
 deleted text end

deleted text begin Subd. 10. deleted text end

deleted text begin Recipient file. deleted text end

deleted text begin Providers of mobile crisis intervention or crisis stabilization
services must maintain a file for each recipient containing the following information:
 deleted text end

deleted text begin (1) individual crisis treatment plans signed by the recipient, mental health professional,
and mental health practitioner who developed the crisis treatment plan, or if the recipient
refused to sign the plan, the date and reason stated by the recipient as to why the recipient
would not sign the plan;
 deleted text end

deleted text begin (2) signed release forms;
 deleted text end

deleted text begin (3) recipient health information and current medications;
 deleted text end

deleted text begin (4) emergency contacts for the recipient;
 deleted text end

deleted text begin (5) case records which document the date of service, place of service delivery, signature
of the person providing the service, and the nature, extent, and units of service. Direct or
telephone contact with the recipient's family or others should be documented;
 deleted text end

deleted text begin (6) required clinical supervision by mental health professionals;
 deleted text end

deleted text begin (7) summary of the recipient's case reviews by staff;
 deleted text end

deleted text begin (8) any written information by the recipient that the recipient wants in the file; and
 deleted text end

deleted text begin (9) an advance directive, if there is one available.
 deleted text end

deleted text begin Documentation in the file must comply with all requirements of the commissioner.
 deleted text end

Subd. 11.

new text begin Crisis new text end treatment plan.

deleted text begin The individual crisis stabilization treatment plan must
include, at a minimum:
 deleted text end

deleted text begin (1) a list of problems identified in the assessment;
 deleted text end

deleted text begin (2) a list of the recipient's strengths and resources;
 deleted text end

deleted text begin (3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement;
 deleted text end

deleted text begin (4) specific objectives directed toward the achievement of each one of the goals;
 deleted text end

deleted text begin (5) documentation of the participants involved in the service planning. The recipient, if
possible, must be a participant. The recipient or the recipient's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the recipient and the recipient's legal guardian. The plan should include
services arranged, including specific providers where applicable;
 deleted text end

deleted text begin (6) planned frequency and type of services initiated;
 deleted text end

deleted text begin (7) a crisis response action plan if a crisis should occur;
 deleted text end

deleted text begin (8) clear progress notes on outcome of goals;
 deleted text end

deleted text begin (9) a written plan must be completed within 24 hours of beginning services with the
recipient; and
 deleted text end

deleted text begin (10) a treatment plan must be developed by a mental health professional or mental health
practitioner under the clinical supervision of a mental health professional. The mental health
professional must approve and sign all treatment plans.
 deleted text end

new text begin (a) Within 24 hours of the recipient's admission, the provider entity must complete the
recipient's crisis treatment plan. The provider entity must:
 new text end

new text begin (1) base the recipient's crisis treatment plan on the recipient's crisis assessment;
 new text end

new text begin (2) consider crisis assistance strategies that have been effective for the recipient in the
past;
 new text end

new text begin (3) for a child recipient, use a child-centered, family-driven, and culturally appropriate
planning process that allows the recipient's parents and guardians to observe or participate
in the recipient's individual and family treatment services, assessment, and treatment
planning;
 new text end

new text begin (4) for an adult recipient, use a person-centered, culturally appropriate planning process
that allows the recipient's family and other natural supports to observe or participate in
treatment services, assessment, and treatment planning;
 new text end

new text begin (5) identify the participants involved in the recipient's treatment planning. The recipient,
if possible, must be a participant;
 new text end

new text begin (6) identify the recipient's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the recipient engage in treatment;
 new text end

new text begin (7) include documentation of referral to and scheduling of services, including specific
providers where applicable;
 new text end

new text begin (8) ensure that the recipient or the recipient's legal guardian approves under section
245I.02, subdivision 2, of the recipient's crisis treatment plan unless a court orders the
recipient's treatment plan under chapter 253B. If the recipient or the recipient's legal guardian
disagrees with the crisis treatment plan, the license holder must document in the client file
the reasons why the recipient disagrees with the crisis treatment plan; and
 new text end

new text begin (9) ensure that a treatment supervisor approves under section 245I.02, subdivision 2, of
the recipient's treatment plan within 24 hours of the recipient's admission if a mental health
practitioner or clinical trainee completes the crisis treatment plan, notwithstanding section
245I.08, subdivision 3.
 new text end

new text begin (b) The provider entity must provide the recipient and the recipient's legal guardian with
a copy of the recipient's crisis treatment plan.
 new text end

Subd. 12.

Excluded services.

The following services are excluded from reimbursement
under this section:

(1) room and board services;

(2) services delivered to a recipient while admitted to an inpatient hospital;

(3) recipient transportation costs may be covered under other medical assistance
provisions, but transportation services are not an adult mental health crisis response service;

(4) services provided and billed by a provider who is not enrolled under medical
assistance to provide adult mental health crisis response services;

(5) services performed by volunteers;

(6) direct billing of time spent "on call" when not delivering services to a recipient;

(7) provider service time included in case management reimbursement. When a provider
is eligible to provide more than one type of medical assistance service, the recipient must
have a choice of provider for each service, unless otherwise provided for by law;

(8) outreach services to potential recipients; deleted text begin and
deleted text end

(9) a mental health service that is not medically necessarydeleted text begin .deleted text end new text begin ;
new text end

new text begin (10) services that a residential treatment center licensed under Minnesota Rules, chapter
2960, provides to a client;
 new text end

new text begin (11) partial hospitalization or day treatment; and
 new text end

new text begin (12) a crisis assessment that a residential provider completes when a daily rate is paid
for the recipient's crisis stabilization.
 new text end

ARTICLE 9

MENTAL HEALTH UNIFORM SERVICE STANDARDS: CONFORMING
CHANGES

Section 1.

Minnesota Statutes 2020, section 62A.152, subdivision 3, is amended to read:


Subd. 3.

Provider discrimination prohibited.

All group policies and group subscriber
contracts that provide benefits for mental or nervous disorder treatments in a hospital must
provide direct reimbursement for those services if performed by a mental health professionaldeleted text begin ,
as defined in sections 245.462, subdivision 18, clauses (1) to (5); and 245.4871, subdivision
27, clauses (1) to (5)deleted text end new text begin qualified according to section 245I.04, subdivision 2new text end , to the extent that
the services and treatment are within the scope of mental health professional licensure.

This subdivision is intended to provide payment of benefits for mental or nervous disorder
treatments performed by a licensed mental health professional in a hospital and is not
intended to change or add benefits for those services provided in policies or contracts to
which this subdivision applies.

Sec. 2.

Minnesota Statutes 2020, section 62A.3094, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) For purposes of this section, the terms defined in
paragraphs (b) to (d) have the meanings given.

(b) "Autism spectrum disorders" means the conditions as determined by criteria set forth
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
the American Psychiatric Association.

(c) "Medically necessary care" means health care services appropriate, in terms of type,
frequency, level, setting, and duration, to the enrollee's condition, and diagnostic testing
and preventative services. Medically necessary care must be consistent with generally
accepted practice parameters as determined by physicians and licensed psychologists who
typically manage patients who have autism spectrum disorders.

(d) "Mental health professional" means a mental health professional deleted text begin as defined in section
245.4871, subdivision 27deleted text end new text begin qualified according to section 245I.04, subdivision 2new text end , clause (1),
(2), (3), (4), or (6), who has training and expertise in autism spectrum disorder and child
development.

Sec. 3.

Minnesota Statutes 2020, section 62Q.096, is amended to read:


62Q.096 CREDENTIALING OF PROVIDERS.

If a health plan company has initially credentialed, as providers in its provider network,
individual providers employed by or under contract with an entity that:

(1) is authorized to bill under section 256B.0625, subdivision 5;

(2) deleted text begin meets the requirements of Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin is a mental
health clinic certified under section 245I.20new text end ;

(3) is designated an essential community provider under section 62Q.19; and

(4) is under contract with the health plan company to provide mental health services,
the health plan company must continue to credential at least the same number of providers
from that entity, as long as those providers meet the health plan company's credentialing
standards.

A health plan company shall not refuse to credential these providers on the grounds that
their provider network has a sufficient number of providers of that type.

Sec. 4.

Minnesota Statutes 2020, section 144.651, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For the purposes of this section, "patient" means a person who is
admitted to an acute care inpatient facility for a continuous period longer than 24 hours, for
the purpose of diagnosis or treatment bearing on the physical or mental health of that person.
For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, "patient" also means a
person who receives health care services at an outpatient surgical center or at a birth center
licensed under section 144.615. "Patient" also means a minor who is admitted to a residential
program as defined in section 253C.01. For purposes of subdivisions 1, 3 to 16, 18, 20 and
30, "patient" also means any person who is receiving mental health treatment on an outpatient
basis or in a community support program or other community-based program. "Resident"
means a person who is admitted to a nonacute care facility including extended care facilities,
nursing homes, and boarding care homes for care required because of prolonged mental or
physical illness or disability, recovery from injury or disease, or advancing age. For purposes
of all subdivisions except subdivisions 28 and 29, "resident" also means a person who is
admitted to a facility licensed as a board and lodging facility under Minnesota Rules, parts
4625.0100 to 4625.2355, new text begin a boarding care home under sections 144.50 to 144.56, new text end or a
supervised living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which
operates a rehabilitation program licensed under chapter 245G new text begin or 245I, new text end or Minnesota Rules,
parts 9530.6510 to 9530.6590.

Sec. 5.

Minnesota Statutes 2020, section 144D.01, subdivision 4, is amended to read:


Subd. 4.

Housing with services establishment or establishment.

(a) "Housing with
services establishment" or "establishment" means:

(1) an establishment providing sleeping accommodations to one or more adult residents,
at least 80 percent of which are 55 years of age or older, and offering or providing, for a
fee, one or more regularly scheduled health-related services or two or more regularly
scheduled supportive services, whether offered or provided directly by the establishment
or by another entity arranged for by the establishment; or

(2) an establishment that registers under section 144D.025.

(b) Housing with services establishment does not include:

(1) a nursing home licensed under chapter 144A;

(2) a hospital, certified boarding care home, or supervised living facility licensed under
sections 144.50 to 144.56;

(3) a board and lodging establishment licensed under chapter 157 and Minnesota Rules,
parts 9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;

(4) a board and lodging establishment which serves as a shelter for battered women or
other similar purpose;

(5) a family adult foster care home licensed by the Department of Human Services;

(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;

(7) residential settings for persons with developmental disabilities in which the services
are licensed under chapter 245D;

(8) a home-sharing arrangement such as when an elderly or disabled person or
single-parent family makes lodging in a private residence available to another person in
exchange for services or rent, or both;

(9) a duly organized condominium, cooperative, common interest community, or owners'
association of the foregoing where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are occupied by individuals
who are the owners, members, or shareholders of the units;

(10) services for persons with developmental disabilities that are provided under a license
under chapter 245D; or

(11) a temporary family health care dwelling as defined in sections 394.307 and 462.3593.

Sec. 6.

Minnesota Statutes 2020, section 144G.08, subdivision 7, as amended by Laws
2020, Seventh Special Session chapter 1, article 6, section 5, is amended to read:


Subd. 7.

Assisted living facility.

"Assisted living facility" means a facility that provides
sleeping accommodations and assisted living services to one or more adults. Assisted living
facility includes assisted living facility with dementia care, and does not include:

(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;

(2) a nursing home licensed under chapter 144A;

(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;

(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;

(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;

(6) a private home in which the residents are related by kinship, law, or affinity with the
provider of services;

(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;

(8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593;

(9) a setting offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;

(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;

(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;

(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;

(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011;

(14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b); or

(15) any establishment that exclusively or primarily serves as a shelter or temporary
shelter for victims of domestic or any other form of violence.

Sec. 7.

Minnesota Statutes 2020, section 148B.5301, subdivision 2, is amended to read:


Subd. 2.

Supervision.

(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).

(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional deleted text begin as defined in section 245.462, subdivision
18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin qualified according to
section 245I.04, subdivision 2new text end , or by a board-approved supervisor, who has at least two
years of postlicensure experience in the delivery of clinical services in the diagnosis and
treatment of mental illnesses and disorders. All supervisors must meet the supervisor
requirements in Minnesota Rules, part 2150.5010.

(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in person. The remaining 25 percent of the required hours may be received by
telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.

(d) The supervised practice must include at least 1,800 hours of clinical client contact.

(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.

Sec. 8.

Minnesota Statutes 2020, section 148E.120, subdivision 2, is amended to read:


Subd. 2.

Alternate supervisors.

(a) The board may approve an alternate supervisor as
determined in this subdivision. The board shall approve up to 25 percent of the required
supervision hours by a deleted text begin licenseddeleted text end mental health professional who is competent and qualified
to provide supervision according to the mental health professional's respective licensing
board, as established by section deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871,
subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .

(b) The board shall approve up to 100 percent of the required supervision hours by an
alternate supervisor if the board determines that:

(1) there are five or fewer supervisors in the county where the licensee practices social
work who meet the applicable licensure requirements in subdivision 1;

(2) the supervisor is an unlicensed social worker who is employed in, and provides the
supervision in, a setting exempt from licensure by section 148E.065, and who has
qualifications equivalent to the applicable requirements specified in sections 148E.100 to
148E.115;

(3) the supervisor is a social worker engaged in authorized social work practice in Iowa,
Manitoba, North Dakota, Ontario, South Dakota, or Wisconsin, and has the qualifications
equivalent to the applicable requirements in sections 148E.100 to 148E.115; or

(4) the applicant or licensee is engaged in nonclinical authorized social work practice
outside of Minnesota and the supervisor meets the qualifications equivalent to the applicable
requirements in sections 148E.100 to 148E.115, or the supervisor is an equivalent mental
health professional, as determined by the board, who is credentialed by a state, territorial,
provincial, or foreign licensing agency; or

(5) the applicant or licensee is engaged in clinical authorized social work practice outside
of Minnesota and the supervisor meets qualifications equivalent to the applicable
requirements in section 148E.115, or the supervisor is an equivalent mental health
professional as determined by the board, who is credentialed by a state, territorial, provincial,
or foreign licensing agency.

(c) In order for the board to consider an alternate supervisor under this section, the
licensee must:

(1) request in the supervision plan and verification submitted according to section
148E.125 that an alternate supervisor conduct the supervision; and

(2) describe the proposed supervision and the name and qualifications of the proposed
alternate supervisor. The board may audit the information provided to determine compliance
with the requirements of this section.

Sec. 9.

Minnesota Statutes 2020, section 148F.11, subdivision 1, is amended to read:


Subdivision 1.

Other professionals.

(a) Nothing in this chapter prevents members of
other professions or occupations from performing functions for which they are qualified or
licensed. This exception includes, but is not limited to: licensed physicians; registered nurses;
licensed practical nurses; licensed psychologists and licensed psychological practitioners;
members of the clergy provided such services are provided within the scope of regular
ministries; American Indian medicine men and women; licensed attorneys; probation officers;
licensed marriage and family therapists; licensed social workers; social workers employed
by city, county, or state agencies; licensed professional counselors; licensed professional
clinical counselors; licensed school counselors; registered occupational therapists or
occupational therapy assistants; Upper Midwest Indian Council on Addictive Disorders
(UMICAD) certified counselors when providing services to Native American people; city,
county, or state employees when providing assessments or case management under Minnesota
Rules, chapter 9530; and individuals defined in section 256B.0623, subdivision 5, paragraph
(a), clauses (1) deleted text begin and (2)deleted text end new text begin to (6)new text end , providing deleted text begin integrated dual diagnosisdeleted text end new text begin co-occurring substance
use disordernew text end treatment in adult mental health rehabilitative programs certified new text begin or licensed
new text end by the Department of Human Services under section new text begin 245I.23, new text end 256B.0622new text begin ,new text end or 256B.0623.

(b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.

(c) Any person who is exempt from licensure under this section must not use a title
incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold himself or herself out to the public by any title or description
stating or implying that he or she is engaged in the practice of alcohol and drug counseling,
or that he or she is licensed to engage in the practice of alcohol and drug counseling, unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the practice
of alcohol and drug counseling are not exempt from the board's jurisdiction solely by the
use of one of the titles in paragraph (a).

Sec. 10.

Minnesota Statutes 2020, section 245.462, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

The definitions in this section apply to sections 245.461 to
deleted text begin 245.486deleted text end new text begin 245.4863new text end .

Sec. 11.

Minnesota Statutes 2020, section 245.462, subdivision 6, is amended to read:


Subd. 6.

Community support services program.

"Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional designed to help adults with serious and persistent mental illness to function
and remain in the community. A community support services program includes:

(1) client outreach,

(2) medication monitoring,

(3) assistance in independent living skills,

(4) development of employability and work-related opportunities,

(5) crisis assistance,

(6) psychosocial rehabilitation,

(7) help in applying for government benefits, and

(8) housing support services.

The community support services program must be coordinated with the case management
services specified in section 245.4711.

Sec. 12.

Minnesota Statutes 2020, section 245.462, subdivision 8, is amended to read:


Subd. 8.

Day treatment services.

"Day treatment," "day treatment services," or "day
treatment program" means deleted text begin a structured program of treatment and care provided to an adult
in or by: (1) a hospital accredited by the joint commission on accreditation of health
organizations and licensed under sections 144.50 to 144.55; (2) a community mental health
center under section 245.62; or (3) an entity that is under contract with the county board to
operate a program that meets the requirements of section 245.4712, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. Day treatment consists of group
psychotherapy and other intensive therapeutic services that are provided at least two days
a week by a multidisciplinary staff under the clinical supervision of a mental health
professional. Day treatment may include education and consultation provided to families
and other individuals as part of the treatment process. The services are aimed at stabilizing
the adult's mental health status, providing mental health services, and developing and
improving the adult's independent living and socialization skills. The goal of day treatment
is to reduce or relieve mental illness and to enable the adult to live in the community. Day
treatment services are not a part of inpatient or residential treatment services. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. The commissioner may limit medical assistance reimbursement
for day treatment to 15 hours per week per persondeleted text end new text begin the treatment services described under
section 256B.0671, subdivision 3new text end .

Sec. 13.

Minnesota Statutes 2020, section 245.462, subdivision 9, is amended to read:


Subd. 9.

Diagnostic assessment.

deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given in
deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .

deleted text begin (b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
 deleted text end

deleted text begin (1) age;
 deleted text end

deleted text begin (2) description of symptoms, including reason for referral;
 deleted text end

deleted text begin (3) history of mental health treatment;
 deleted text end

deleted text begin (4) cultural influences and their impact on the client; and
 deleted text end

deleted text begin (5) mental status examination.
 deleted text end

deleted text begin (c) On the basis of the initial components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
 deleted text end

deleted text begin (d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
 deleted text end

deleted text begin (e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
 deleted text end

deleted text begin (f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
 deleted text end

deleted text begin (g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.
 deleted text end

Sec. 14.

Minnesota Statutes 2020, section 245.462, subdivision 14, is amended to read:


Subd. 14.

Individual treatment plan.

"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for an adult with mental illness that is developed
by a service provider under the clinical supervision of a mental health professional on the
basis of a diagnostic assessment. The plan identifies goals and objectives of treatment,
treatment strategy, a schedule for accomplishing treatment goals and objectives, and the
individual responsible for providing treatment to the adult with mental illnessdeleted text end new text begin the formulation
of planned services that are responsive to the needs and goals of a client. An individual
treatment plan must be completed according to section 245I.10, subdivisions 7 and 8new text end .

Sec. 15.

Minnesota Statutes 2020, section 245.462, subdivision 16, is amended to read:


Subd. 16.

Mental health funds.

"Mental health funds" are funds expended under sections
245.73 and 256E.12, federal mental health block grant funds, and funds expended under
section 256D.06 to facilities licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670.

Sec. 16.

Minnesota Statutes 2020, section 245.462, subdivision 17, is amended to read:


Subd. 17.

Mental health practitioner.

deleted text begin (a)deleted text end "Mental health practitioner" means a new text begin staff
new text end person deleted text begin providing services to adults with mental illness or children with emotional disturbance
who is qualified in at least one of the ways described in paragraphs (b) to (g). A mental
health practitioner for a child client must have training working with children. A mental
health practitioner for an adult client must have training working with adultsdeleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end .

deleted text begin (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:
 deleted text end

deleted text begin (1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
 deleted text end

deleted text begin (i) mental illness, substance use disorder, or emotional disturbance; or
 deleted text end

deleted text begin (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;
 deleted text end

deleted text begin (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 adults with mental illness or children with emotional disturbance, 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;
 deleted text end

deleted text begin (3) is working in a day treatment program under section 245.4712, subdivision 2; or
 deleted text end

deleted text begin (4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
 deleted text end

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

deleted text begin (1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
 deleted text end

deleted text begin (i) mental illness, substance use disorder, or emotional disturbance; or
 deleted text end

deleted text begin (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
 deleted text end

deleted text begin (2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
 deleted text end

deleted text begin (i) mental illness, emotional disturbance, 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
 deleted text end

deleted text begin (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.
 deleted text end

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

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

deleted text begin (1) holds a master's or other graduate degree in behavioral sciences or related fields; or
 deleted text end

deleted text begin (2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
 deleted text end

deleted text begin (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.
 deleted text end

deleted text begin (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:
 deleted text end

deleted text begin (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
 deleted text end

deleted text begin (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.
 deleted text end

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

deleted text begin (i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
 deleted text end

Sec. 17.

Minnesota Statutes 2020, section 245.462, subdivision 18, is amended to read:


Subd. 18.

Mental health professional.

"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the treatment of mental illness who is qualified in at least one
of the following ways:deleted text end new text begin qualified according to section 245I.04, subdivision 2.
new text end

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

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

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

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

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

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

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

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

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

Sec. 18.

Minnesota Statutes 2020, section 245.462, subdivision 21, is amended to read:


Subd. 21.

Outpatient services.

"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to adults with mental
illness who live outside a hospital. Outpatient services include clinical activities such as
individual, group, and family therapy; individual treatment planning; diagnostic assessments;
medication management; and psychological testing.

Sec. 19.

Minnesota Statutes 2020, section 245.462, subdivision 23, is amended to read:


Subd. 23.

Residential treatment.

"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for adults with mental illness
under new text begin chapter 245I, new text end Minnesota Rules, parts 9520.0500 to 9520.0670new text begin ,new text end or other rules adopted
by the commissioner.

Sec. 20.

Minnesota Statutes 2020, section 245.462, is amended by adding a subdivision
to read:


new text begin Subd. 27. new text end

new text begin Treatment supervision. new text end

new text begin "Treatment supervision" means the treatment
supervision described under section 245I.06.
 new text end

Sec. 21.

Minnesota Statutes 2020, section 245.4661, subdivision 5, is amended to read:


Subd. 5.

Planning for pilot projects.

(a) Each local plan for a pilot project, with the
exception of the placement of a Minnesota specialty treatment facility as defined in paragraph
(c), must be developed under the direction of the county board, or multiple county boards
acting jointly, as the local mental health authority. The planning process for each pilot shall
include, but not be limited to, mental health consumers, families, advocates, local mental
health advisory councils, local and state providers, representatives of state and local public
employee bargaining units, and the department of human services. As part of the planning
process, the county board or boards shall designate a managing entity responsible for receipt
of funds and management of the pilot project.

(b) For Minnesota specialty treatment facilities, the commissioner shall issue a request
for proposal for regions in which a need has been identified for services.

(c) For purposes of this section, "Minnesota specialty treatment facility" is defined as
an intensive residential treatment service new text begin licensed new text end under deleted text begin section 256B.0622, subdivision 2,
paragraph (b)deleted text end new text begin chapter 245Inew text end .

Sec. 22.

Minnesota Statutes 2020, section 245.4662, subdivision 1, is amended to read:


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
eligible applicants.

(c) "Eligible applicant" means an eligible county, Indian tribe, mental health service
provider, hospital, 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.0622deleted text begin ,
subdivision 2deleted text end .

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

Sec. 23.

Minnesota Statutes 2020, section 245.467, subdivision 2, is amended to read:


Subd. 2.

Diagnostic assessment.

deleted text begin All providers of residential, acute care hospital inpatient,
and regional treatment centers must complete a diagnostic assessment for each of their
clients within five days of admission. Providers of day treatment services must complete a
diagnostic assessment within five days after the adult's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available and has
been completed within three years preceding admission, only an adult diagnostic assessment
update is necessary. An "adult diagnostic assessment update" means a written summary by
a mental health professional of the adult's current mental health status and service needs
and includes a face-to-face interview with the adult. If the adult's mental health status has
changed markedly since the adult's most recent diagnostic assessment, a new diagnostic
assessment is required. Compliance with the provisions of this subdivision does not ensure
eligibility for medical assistance reimbursement under chapter 256B. deleted text end new text begin Providers of services
governed by this section must complete a diagnostic assessment according to the standards
of section 245I.10, subdivisions 4 to 6.
 new text end

Sec. 24.

Minnesota Statutes 2020, section 245.467, subdivision 3, is amended to read:


Subd. 3.

Individual treatment plans.

deleted text begin All providers of outpatient services, day treatment
services, residential treatment, acute care hospital inpatient treatment, and all regional
treatment centers must develop an individual treatment plan for each of their adult clients.
The individual treatment plan must be based on a diagnostic assessment. To the extent
possible, the adult client shall be involved in all phases of developing and implementing
the individual treatment plan. Providers of residential treatment and acute care hospital
inpatient treatment, and all regional treatment centers must develop the individual treatment
plan within ten days of client intake and must review the individual treatment plan every
90 days after intake. Providers of day treatment services must develop the individual
treatment plan before the completion of five working days in which service is provided or
within 30 days after the diagnostic assessment is completed or obtained, whichever occurs
first. Providers of outpatient services must develop the individual treatment plan within 30
days after the diagnostic assessment is completed or obtained or by the end of the second
session of an outpatient service, not including the session in which the diagnostic assessment
was provided, whichever occurs first. Outpatient and day treatment services providers must
review the individual treatment plan every 90 days after intake. deleted text end new text begin Providers of services
governed by this section must complete an individual treatment plan according to the
standards of section 245I.10, subdivisions 7 and 8.
 new text end

Sec. 25.

Minnesota Statutes 2020, section 245.470, subdivision 1, is amended to read:


Subdivision 1.

Availability of outpatient services.

(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of adults with
mental illness residing in the county. Services may be provided directly by the county
through county-operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved by the
commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter 245Inew text end ;
by contract with privately operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved
by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter
245Inew text end ; by contract with hospital mental health outpatient programs certified by the Joint
Commission on Accreditation of Hospital Organizations; or by contract with a deleted text begin licenseddeleted text end
mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6)deleted text end .
Clients may be required to pay a fee according to section 245.481. Outpatient services
include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating an adult's mental health needs through therapy;

(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication; and

(7) preventing placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needs.

(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the client can best be served outside the county.

Sec. 26.

Minnesota Statutes 2020, section 245.4712, subdivision 2, is amended to read:


Subd. 2.

Day treatment services provided.

(a) Day treatment services must be developed
as a part of the community support services available to adults with serious and persistent
mental illness residing in the county. Adults may be required to pay a fee according to
section 245.481. Day treatment services must be designed to:

(1) provide a structured environment for treatment;

(2) provide support for residing in the community;

(3) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client need;

(4) coordinate with or be offered in conjunction with a local education agency's special
education program; and

(5) operate on a continuous basis throughout the year.

(b) deleted text begin For purposes of complying with medical assistance requirements, an adult day
treatment program must comply with the method of clinical supervision specified in
Minnesota Rules, part 9505.0371, subpart 4. The clinical supervision must be performed
by a qualified supervisor who satisfies the requirements of Minnesota Rules, part 9505.0371,
subpart 5.deleted text end new text begin An adult day treatment program must comply with medical assistance requirements
in section 256B.0671, subdivision 3.
new text end

deleted text begin A day treatment program must demonstrate compliance with this clinical supervision
requirement by the commissioner's review and approval of the program according to
Minnesota Rules, part 9505.0372, subpart 8.
 deleted text end

(c) County boards may request a waiver from including day treatment services if they
can document that:

(1) an alternative plan of care exists through the county's community support services
for clients who would otherwise need day treatment services;

(2) day treatment, if included, would be duplicative of other components of the
community support services; and

(3) county demographics and geography make the provision of day treatment services
cost ineffective and infeasible.

Sec. 27.

Minnesota Statutes 2020, section 245.472, subdivision 2, is amended to read:


Subd. 2.

Specific requirements.

Providers of residential services must be licensed under
new text begin chapter 245I or new text end applicable rules adopted by the commissioner deleted text begin and must be clinically
supervised by a mental health professional. Persons employed in facilities licensed under
Minnesota Rules, parts 9520.0500 to 9520.0670, in the capacity of program director as of
July 1, 1987, in accordance with Minnesota Rules, parts 9520.0500 to 9520.0670, may be
allowed to continue providing clinical supervision within a facility, provided they continue
to be employed as a program director in a facility licensed under Minnesota Rules, parts
9520.0500 to 9520.0670deleted text end .new text begin Residential services must be provided under treatment supervision.
new text end

Sec. 28.

Minnesota Statutes 2020, section 245.4863, is amended to read:


245.4863 INTEGRATED CO-OCCURRING DISORDER TREATMENT.

(a) The commissioner shall require individuals who perform chemical dependency
assessments to screen clients for co-occurring mental health disorders, and staff who perform
mental health diagnostic assessments to screen for co-occurring substance use disorders.
Screening tools must be approved by the commissioner. If a client screens positive for a
co-occurring mental health or substance use disorder, the individual performing the screening
must document what actions will be taken in response to the results and whether further
assessments must be performed.

(b) Notwithstanding paragraph (a), screening is not required when:

(1) the presence of co-occurring disorders was documented for the client in the past 12
months;

(2) the client is currently receiving co-occurring disorders treatment;

(3) the client is being referred for co-occurring disorders treatment; or

(4) a mental health professionaldeleted text begin , as defined in Minnesota Rules, part 9505.0370, subpart
18,deleted text end who is competent to perform diagnostic assessments of co-occurring disorders is
performing a diagnostic assessment deleted text begin that meets the requirements in Minnesota Rules, part
9533.0090, subpart 5,deleted text end to identify whether the client may have co-occurring mental health
and chemical dependency disorders. If an individual is identified to have co-occurring
mental health and substance use disorders, the assessing mental health professional must
document what actions will be taken to address the client's co-occurring disorders.

(c) The commissioner shall adopt rules as necessary to implement this section. The
commissioner shall ensure that the rules are effective on July 1, 2013, thereby establishing
a certification process for integrated dual disorder treatment providers and a system through
which individuals receive integrated dual diagnosis treatment if assessed as having both a
substance use disorder and either a serious mental illness or emotional disturbance.

(d) The commissioner shall apply for any federal waivers necessary to secure, to the
extent allowed by law, federal financial participation for the provision of integrated dual
diagnosis treatment to persons with co-occurring disorders.

Sec. 29.

Minnesota Statutes 2020, section 245.4871, subdivision 9a, is amended to read:


Subd. 9a.

Crisis deleted text begin assistancedeleted text end new text begin planningnew text end .

"Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " means deleted text begin assistance to
the child, the child's family, and all providers of services to the child to: recognize factors
precipitating a mental health crisis, identify behaviors related to the crisis, and be informed
of available resources to resolve the crisis. Crisis assistance requires the development of a
plan which addresses prevention and intervention strategies to be used in a potential crisis.
Other interventions include: (1) arranging for admission to acute care hospital inpatient
treatmentdeleted text end new text begin the development of a written plan to assist a child's family in preventing and
addressing a potential crisis and is distinct from the immediate provision of mental health
crisis services as defined in section 256B.0624. The plan must address prevention,
deescalation, and intervention strategies to be used in a crisis. The plan identifies factors
that might precipitate a crisis, behaviors or symptoms related to the emergence of a crisis,
and the resources available to resolve a crisis. The plan must address the following potential
needs: (1) acute carenew text end ; (2) crisis placement; (3) community resources for follow-up; and (4)
emotional support to the family during crisis. Crisis deleted text begin assistancedeleted text end new text begin planningnew text end does not include
services designed to secure the safety of a child who is at risk of abuse or neglect or necessary
emergency services.

Sec. 30.

Minnesota Statutes 2020, section 245.4871, subdivision 10, is amended to read:


Subd. 10.

Day treatment services.

"Day treatment," "day treatment services," or "day
treatment program" means a structured program of treatment and care provided to a child
in:

(1) an outpatient hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;

(2) a community mental health center under section 245.62;

(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475; deleted text begin or
deleted text end

(4) an entity that operates a program that meets the requirements of section 245.4884,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is under contract
with an entity that is under contract with a county boarddeleted text begin .deleted text end new text begin ; and
new text end

new text begin (5) a program certified under section 256B.0943.
 new text end

Day treatment consists of group psychotherapy and other intensive therapeutic services
that are provided for a minimum two-hour time block by a multidisciplinary staff under the
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. Day treatment may include
education and consultation provided to families and other individuals as an extension of the
treatment process. The services are aimed at stabilizing the child's mental health status, and
developing and improving the child's daily independent living and socialization skills. Day
treatment services are distinguished from day care by their structured therapeutic program
of psychotherapy services. Day treatment services are not a part of inpatient hospital or
residential treatment services.

A day treatment service must be available to a child up to 15 hours a week throughout
the year and must be coordinated with, integrated with, or part of an education program
offered by the child's school.

Sec. 31.

Minnesota Statutes 2020, section 245.4871, subdivision 11a, is amended to read:


Subd. 11a.

Diagnostic assessment.

deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given
in deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .

deleted text begin (b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
 deleted text end

deleted text begin (1) age;
 deleted text end

deleted text begin (2) description of symptoms, including reason for referral;
 deleted text end

deleted text begin (3) history of mental health treatment;
 deleted text end

deleted text begin (4) cultural influences and their impact on the client; and
 deleted text end

deleted text begin (5) mental status examination.
 deleted text end

deleted text begin (c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
 deleted text end

deleted text begin (d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
 deleted text end

deleted text begin (e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
 deleted text end

deleted text begin (f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
 deleted text end

Sec. 32.

Minnesota Statutes 2020, section 245.4871, subdivision 17, is amended to read:


Subd. 17.

Family community support services.

"Family community support services"
means services provided under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional and designed to help each child with severe emotional disturbance to function
and remain with the child's family in the community. Family community support services
do not include acute care hospital inpatient treatment, residential treatment services, or
regional treatment center services. Family community support services include:

(1) client outreach to each child with severe emotional disturbance and the child's family;

(2) medication monitoring where necessary;

(3) assistance in developing independent living skills;

(4) assistance in developing parenting skills necessary to address the needs of the child
with severe emotional disturbance;

(5) assistance with leisure and recreational activities;

(6) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis placement and respite care;

(7) professional home-based family treatment;

(8) foster care with therapeutic supports;

(9) day treatment;

(10) assistance in locating respite care and special needs day care; and

(11) assistance in obtaining potential financial resources, including those benefits listed
in section 245.4884, subdivision 5.

Sec. 33.

Minnesota Statutes 2020, section 245.4871, subdivision 21, is amended to read:


Subd. 21.

Individual treatment plan.

"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for a child with an emotional disturbance that is
developed by a service provider under the clinical supervision of a mental health professional
on the basis of a diagnostic assessment. An individual treatment plan for a child must be
developed in conjunction with the family unless clinically inappropriate. The plan identifies
goals and objectives of treatment, treatment strategy, a schedule for accomplishing treatment
goals and objectives, and the individuals responsible for providing treatment to the child
with an emotional disturbancedeleted text end new text begin the formulation of planned services that are responsive to
the needs and goals of a client. An individual treatment plan must be completed according
to section 245I.10, subdivisions 7 and 8new text end .

Sec. 34.

Minnesota Statutes 2020, section 245.4871, subdivision 26, is amended to read:


Subd. 26.

Mental health practitioner.

"Mental health practitioner" deleted text begin has the meaning
given in section 245.462, subdivision 17deleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .

Sec. 35.

Minnesota Statutes 2020, section 245.4871, subdivision 27, is amended to read:


Subd. 27.

Mental health professional.

"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the diagnosis and treatment of children's emotional disorders.
A mental health professional must have training and experience in working with children
consistent with the age group to which the mental health professional is assigned. A mental
health professional must be qualified in at least one of the following ways:deleted text end new text begin qualified according
to section 245I.04, subdivision 2.
new text end

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

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

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

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

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

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

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

Sec. 36.

Minnesota Statutes 2020, section 245.4871, subdivision 29, is amended to read:


Subd. 29.

Outpatient services.

"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to children with emotional
disturbances who live outside a hospital. Outpatient services include clinical activities such
as individual, group, and family therapy; individual treatment planning; diagnostic
assessments; medication management; and psychological testing.

Sec. 37.

Minnesota Statutes 2020, section 245.4871, subdivision 31, is amended to read:


Subd. 31.

Professional home-based family treatment.

"Professional home-based family
treatment" means intensive mental health services provided to children because of an
emotional disturbance (1) who are at risk of out-of-home placement; (2) who are in
out-of-home placement; or (3) who are returning from out-of-home placement. Services
are provided to the child and the child's family primarily in the child's home environment.
Services may also be provided in the child's school, child care setting, or other community
setting appropriate to the child. Services must be provided on an individual family basis,
must be child-oriented and family-oriented, and must be designed using information from
diagnostic and functional assessments to meet the specific mental health needs of the child
and the child's family. Examples of services are: (1) individual therapy; (2) family therapy;
(3) client outreach; (4) assistance in developing individual living skills; (5) assistance in
developing parenting skills necessary to address the needs of the child; (6) assistance with
leisure and recreational services; (7) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis respite care
and arranging for crisis placement; and (8) assistance in locating respite and child care.
Services must be coordinated with other services provided to the child and family.

Sec. 38.

Minnesota Statutes 2020, section 245.4871, subdivision 32, is amended to read:


Subd. 32.

Residential treatment.

"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for children with emotional
disturbances under Minnesota Rules, parts 2960.0580 to 2960.0700, or other rules adopted
by the commissioner.

Sec. 39.

Minnesota Statutes 2020, section 245.4871, subdivision 34, is amended to read:


Subd. 34.

Therapeutic support of foster care.

"Therapeutic support of foster care"
means the mental health training and mental health support services and deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision provided by a mental health professional to foster families caring for children
with severe emotional disturbance to provide a therapeutic family environment and support
for the child's improved functioning.new text begin Therapeutic support of foster care includes services
provided under section 256B.0946.
new text end

Sec. 40.

Minnesota Statutes 2020, section 245.4871, is amended by adding a subdivision
to read:


new text begin Subd. 36. new text end

new text begin Treatment supervision. new text end

new text begin "Treatment supervision" means the treatment
supervision described under section 245I.06.
 new text end

Sec. 41.

Minnesota Statutes 2020, section 245.4876, subdivision 2, is amended to read:


Subd. 2.

Diagnostic assessment.

deleted text begin All residential treatment facilities and acute care
hospital inpatient treatment facilities that provide mental health services for children must
complete a diagnostic assessment for each of their child clients within five working days
of admission. Providers of day treatment services for children must complete a diagnostic
assessment within five days after the child's second visit or 30 days after intake, whichever
occurs first. In cases where a diagnostic assessment is available and has been completed
within 180 days preceding admission, only updating is necessary. "Updating" means a
written summary by a mental health professional of the child's current mental health status
and service needs. If the child's mental health status has changed markedly since the child's
most recent diagnostic assessment, a new diagnostic assessment is required. Compliance
with the provisions of this subdivision does not ensure eligibility for medical assistance
reimbursement under chapter 256B. deleted text end new text begin Providers of services governed by this section shall
complete a diagnostic assessment according to the standards of section 245I.10, subdivisions
4 to 6.
 new text end

Sec. 42.

Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:


Subd. 3.

Individual treatment plans.

deleted text begin All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intake, except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9.
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake. deleted text end new text begin Providers of services governed by this
section shall complete an individual treatment plan according to the standards of section
245I.10, subdivisions 7 and 8.
 new text end

Sec. 43.

Minnesota Statutes 2020, section 245.488, subdivision 1, is amended to read:


Subdivision 1.

Availability of outpatient services.

(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of each child
with emotional disturbance residing in the county and the child's family. Services may be
provided directly by the county through county-operated deleted text begin mental health centers ordeleted text end mental
health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting
the standards of chapter 245Inew text end ; by contract with privately operated deleted text begin mental health centers ordeleted text end
mental health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin
meeting the standards of chapter 245Inew text end ; by contract with hospital mental health outpatient
programs certified by the Joint Commission on Accreditation of Hospital Organizations;
or by contract with a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.4871,
subdivision 27, clauses (1) to (6)deleted text end . A child or a child's parent may be required to pay a fee
based in accordance with section 245.481. Outpatient services include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating the child's mental health needs through therapy; and

(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication.

(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.

(c) Outpatient services offered by the county board to prevent placement must be at the
level of treatment appropriate to the child's diagnostic assessment.

Sec. 44.

Minnesota Statutes 2020, section 245.4901, subdivision 2, is amended to read:


Subd. 2.

Eligible applicants.

An eligible applicant for school-linked mental health grants
is an entity that is:

(1) new text begin a mental health clinic new text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin
section 245I.20new text end ;

(2) a community mental health center under section 256B.0625, subdivision 5;

(3) an Indian health service facility or a facility owned and operated by a tribe or tribal
organization operating under United States Code, title 25, section 5321;

(4) a provider of children's therapeutic services and supports as defined in section
256B.0943; or

(5) enrolled in medical assistance as a mental health or substance use disorder provider
agency and employs at least two full-time equivalent mental health professionals qualified
according to section deleted text begin 245I.16deleted text end new text begin 245I.04new text end , subdivision 2, or two alcohol and drug counselors
licensed or exempt from licensure under chapter 148F who are qualified to provide clinical
services to children and families.

Sec. 45.

Minnesota Statutes 2020, section 245.62, subdivision 2, is amended to read:


Subd. 2.

Definition.

A community mental health center is a private nonprofit corporation
or public agency approved under the deleted text begin rules promulgated by the commissioner pursuant to
subdivision 4deleted text end new text begin standards of section 256B.0625, subdivision 5new text end .

Sec. 46.

Minnesota Statutes 2020, section 245.735, subdivision 3, is amended to read:


Subd. 3.

Certified community behavioral health clinics.

(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs). Entities that choose to be CCBHCs must:

(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;

(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;

(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;

(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;

(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;

(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization services; screening,
assessment, and diagnosis services, including risk assessments and level of care
determinations; person- and family-centered treatment planning; outpatient mental health
and substance use services; targeted case management; psychiatric rehabilitation services;
peer support and counselor services and family support services; and intensive
community-based mental health services, including mental health services for members of
the armed forces and veterans;

(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:

(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and

(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;

(8) be deleted text begin certified asdeleted text end mental health clinics deleted text begin under section 245.69, subdivision 2deleted text end new text begin meeting the
standards of chapter 245Inew text end ;

(9) deleted text begin comply with standards relating to mental health services in Minnesota Rules, parts
9505.0370 to 9505.0372deleted text end new text begin be a co-occurring disorder specialistnew text end ;

(10) be licensed to provide substance use disorder treatment under chapter 245G;

(11) be certified to provide children's therapeutic services and supports under section
256B.0943;

(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;

(13) be enrolled to provide mental health crisis response services under deleted text begin sectionsdeleted text end new text begin sectionnew text end
256B.0624 deleted text begin and 256B.0944deleted text end ;

(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;

(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;

(16) provide services that comply with the evidence-based practices described in
paragraph (e); and

(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.

(b) If an entity is unable to provide one or more of the services listed in paragraph (a),
clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has
a current contract with another entity that has the required authority to provide that service
and that meets federal CCBHC criteria as a designated collaborating organization, or, to
the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral
arrangement. The CCBHC must meet federal requirements regarding the type and scope of
services to be provided directly by the CCBHC.

(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.

(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements.
If standards overlap, the commissioner may substitute all or a part of a licensure or
certification that is substantially the same as another licensure or certification. The
commissioner shall consult with stakeholders, as described in subdivision 4, before granting
variances under this provision. For the CCBHC that is certified but not approved for
prospective payment under section 256B.0625, subdivision 5m, the commissioner may
grant a variance under this paragraph if the variance does not increase the state share of
costs.

(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.

(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.

Sec. 47.

Minnesota Statutes 2020, section 245A.04, subdivision 5, is amended to read:


Subd. 5.

Commissioner's right of access.

(a) When the commissioner is exercising the
powers conferred by this chapter, deleted text begin sections 245.69 anddeleted text end new text begin sectionnew text end 626.557, and chapter 260E,
the commissioner must be given access to:

(1) the physical plant and grounds where the program is provided;

(2) documents and records, including records maintained in electronic format;

(3) persons served by the program; and

(4) staff and personnel records of current and former staff whenever the program is in
operation and the information is relevant to inspections or investigations conducted by the
commissioner. Upon request, the license holder must provide the commissioner verification
of documentation of staff work experience, training, or educational requirements.

The commissioner must be given access without prior notice and as often as the
commissioner considers necessary if the commissioner is investigating alleged maltreatment,
conducting a licensing inspection, or investigating an alleged violation of applicable laws
or rules. In conducting inspections, the commissioner may request and shall receive assistance
from other state, county, and municipal governmental agencies and departments. The
applicant or license holder shall allow the commissioner to photocopy, photograph, and
make audio and video tape recordings during the inspection of the program at the
commissioner's expense. The commissioner shall obtain a court order or the consent of the
subject of the records or the parents or legal guardian of the subject before photocopying
hospital medical records.

(b) Persons served by the program have the right to refuse to consent to be interviewed,
photographed, or audio or videotaped. Failure or refusal of an applicant or license holder
to fully comply with this subdivision is reasonable cause for the commissioner to deny the
application or immediately suspend or revoke the license.

Sec. 48.

Minnesota Statutes 2020, section 245A.10, subdivision 4, is amended to read:


Subd. 4.

License or certification fee for certain programs.

(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:

Licensed Capacity
 Child Care Center
License Fee
1 to 24 persons
 $200
25 to 49 persons
 $300
50 to 74 persons
 $400
75 to 99 persons
 $500
100 to 124 persons
 $600
125 to 149 persons
 $700
150 to 174 persons
 $800
175 to 199 persons
 $900
200 to 224 persons
 $1,000
225 or more persons
 $1,100

(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:

License Holder Annual Revenue
 License Fee
less than or equal to $10,000
 $200
greater than $10,000 but less than or
equal to $25,000
 $300
greater than $25,000 but less than or
equal to $50,000
 $400
greater than $50,000 but less than or
equal to $100,000
 $500
greater than $100,000 but less than or
equal to $150,000
 $600
greater than $150,000 but less than or
equal to $200,000
 $800
greater than $200,000 but less than or
equal to $250,000
 $1,000
greater than $250,000 but less than or
equal to $300,000
 $1,200
greater than $300,000 but less than or
equal to $350,000
 $1,400
greater than $350,000 but less than or
equal to $400,000
 $1,600
greater than $400,000 but less than or
equal to $450,000
 $1,800
greater than $450,000 but less than or
equal to $500,000
 $2,000
greater than $500,000 but less than or
equal to $600,000
 $2,250
greater than $600,000 but less than or
equal to $700,000
 $2,500
greater than $700,000 but less than or
equal to $800,000
 $2,750
greater than $800,000 but less than or
equal to $900,000
 $3,000
greater than $900,000 but less than or
equal to $1,000,000
 $3,250
greater than $1,000,000 but less than or
equal to $1,250,000
 $3,500
greater than $1,250,000 but less than or
equal to $1,500,000
 $3,750
greater than $1,500,000 but less than or
equal to $1,750,000
 $4,000
greater than $1,750,000 but less than or
equal to $2,000,000
 $4,250
greater than $2,000,000 but less than or
equal to $2,500,000
 $4,500
greater than $2,500,000 but less than or
equal to $3,000,000
 $4,750
greater than $3,000,000 but less than or
equal to $3,500,000
 $5,000
greater than $3,500,000 but less than or
equal to $4,000,000
 $5,500
greater than $4,000,000 but less than or
equal to $4,500,000
 $6,000
greater than $4,500,000 but less than or
equal to $5,000,000
 $6,500
greater than $5,000,000 but less than or
equal to $7,500,000
 $7,000
greater than $7,500,000 but less than or
equal to $10,000,000
 $8,500
greater than $10,000,000 but less than or
equal to $12,500,000
 $10,000
greater than $12,500,000 but less than or
equal to $15,000,000
 $14,000
greater than $15,000,000
 $18,000

(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.

(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.

(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.

(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).

(c) A chemical dependency treatment program licensed under chapter 245G, to provide
chemical dependency treatment shall pay an annual nonrefundable license fee based on the
following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $600
25 to 49 persons
 $800
50 to 74 persons
 $1,000
75 to 99 persons
 $1,200
100 or more persons
 $1,400

(d) A chemical dependency program licensed under Minnesota Rules, parts 9530.6510
to 9530.6590, to provide detoxification services shall pay an annual nonrefundable license
fee based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $760
25 to 49 persons
 $960
50 or more persons
 $1,160

(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $1,000
25 to 49 persons
 $1,100
50 to 74 persons
 $1,200
75 to 99 persons
 $1,300
100 or more persons
 $1,400

(f) A residential facility licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670, to serve persons with mental illness shall pay an annual
nonrefundable license fee based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $2,525
25 or more persons
 $2,725

(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $450
25 to 49 persons
 $650
50 to 74 persons
 $850
75 to 99 persons
 $1,050
100 or more persons
 $1,250

(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.

(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.

(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $500
25 to 49 persons
 $700
50 to 74 persons
 $900
75 to 99 persons
 $1,100
100 or more persons
 $1,300

(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.

(l) A deleted text begin mental health center ordeleted text end mental health clinic requesting certification deleted text begin for purposes
of insurance and subscriber contract reimbursementdeleted text end under deleted text begin Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin section 245I.20new text end , shall pay a certification fee of $1,550 per year. If the mental
health center or mental health clinic provides services at a primary location with satellite
facilities, the satellite facilities shall be certified with the primary location without an
additional charge.

Sec. 49.

Minnesota Statutes 2020, section 245A.65, subdivision 2, is amended to read:


Subd. 2.

Abuse prevention plans.

All license holders shall establish and enforce ongoing
written program abuse prevention plans and individual abuse prevention plans as required
under section 626.557, subdivision 14.

(a) The scope of the program abuse prevention plan is limited to the population, physical
plant, and environment within the control of the license holder and the location where
licensed services are provided. In addition to the requirements in section 626.557, subdivision
14, the program abuse prevention plan shall meet the requirements in clauses (1) to (5).

(1) The assessment of the population shall include an evaluation of the following factors:
age, gender, mental functioning, physical and emotional health or behavior of the client;
the need for specialized programs of care for clients; the need for training of staff to meet
identified individual needs; and the knowledge a license holder may have regarding previous
abuse that is relevant to minimizing risk of abuse for clients.

(2) The assessment of the physical plant where the licensed services are provided shall
include an evaluation of the following factors: the condition and design of the building as
it relates to the safety of the clients; and the existence of areas in the building which are
difficult to supervise.

(3) The assessment of the environment for each facility and for each site when living
arrangements are provided by the agency shall include an evaluation of the following factors:
the location of the program in a particular neighborhood or community; the type of grounds
and terrain surrounding the building; the type of internal programming; and the program's
staffing patterns.

(4) The license holder shall provide an orientation to the program abuse prevention plan
for clients receiving services. If applicable, the client's legal representative must be notified
of the orientation. The license holder shall provide this orientation for each new person
within 24 hours of admission, or for persons who would benefit more from a later orientation,
the orientation may take place within 72 hours.

(5) The license holder's governing body or the governing body's delegated representative
shall review the plan at least annually using the assessment factors in the plan and any
substantiated maltreatment findings that occurred since the last review. The governing body
or the governing body's delegated representative shall revise the plan, if necessary, to reflect
the review results.

(6) A copy of the program abuse prevention plan shall be posted in a prominent location
in the program and be available upon request to mandated reporters, persons receiving
services, and legal representatives.

(b) In addition to the requirements in section 626.557, subdivision 14, the individual
abuse prevention plan shall meet the requirements in clauses (1) and (2).

(1) The plan shall include a statement of measures that will be taken to minimize the
risk of abuse to the vulnerable adult when the individual assessment required in section
626.557, subdivision 14, paragraph (b), indicates the need for measures in addition to the
specific measures identified in the program abuse prevention plan. The measures shall
include the specific actions the program will take to minimize the risk of abuse within the
scope of the licensed services, and will identify referrals made when the vulnerable adult
is susceptible to abuse outside the scope or control of the licensed services. When the
assessment indicates that the vulnerable adult does not need specific risk reduction measures
in addition to those identified in the program abuse prevention plan, the individual abuse
prevention plan shall document this determination.

(2) An individual abuse prevention plan shall be developed for each new person as part
of the initial individual program plan or service plan required under the applicable licensing
rulenew text begin or statutenew text end . The review and evaluation of the individual abuse prevention plan shall be
done as part of the review of the program plan deleted text begin ordeleted text end new text begin ,new text end service plannew text begin , or treatment plannew text end . The person
receiving services shall participate in the development of the individual abuse prevention
plan to the full extent of the person's abilities. If applicable, the person's legal representative
shall be given the opportunity to participate with or for the person in the development of
the plan. The interdisciplinary team shall document the review of all abuse prevention plans
at least annually, using the individual assessment and any reports of abuse relating to the
person. The plan shall be revised to reflect the results of this review.

Sec. 50.

Minnesota Statutes 2020, section 245D.02, subdivision 20, is amended to read:


Subd. 20.

Mental health crisis intervention team.

"Mental health crisis intervention
team" means a mental health crisis response provider as identified in section 256B.0624deleted text begin ,
subdivision 2, paragraph (d), for adults, and in section 256B.0944, subdivision 1, paragraph
(d), for childrendeleted text end .

Sec. 51.

Minnesota Statutes 2020, section 256B.0615, subdivision 1, is amended to read:


Subdivision 1.

Scope.

Medical assistance covers mental health certified peer specialist
services, as established in subdivision 2, subject to federal approval, if provided to recipients
who are eligible for services under sections 256B.0622, 256B.0623, and 256B.0624 and
are provided by a new text begin mental health new text end certified peer specialist who has completed the training
under subdivision 5new text begin and is qualified according to section 245I.04, subdivision 10new text end .

Sec. 52.

Minnesota Statutes 2020, section 256B.0615, subdivision 5, is amended to read:


Subd. 5.

Certified peer specialist training and certification.

The commissioner of
human services shall develop a training and certification process for certified peer specialistsdeleted text begin ,
who must be at least 21 years of agedeleted text end . The candidates must have had a primary diagnosis of
mental illness, be a current or former consumer of mental health services, and must
demonstrate leadership and advocacy skills and a strong dedication to recovery. The training
curriculum must teach participating consumers specific skills relevant to providing peer
support to other consumers. In addition to initial training and certification, the commissioner
shall develop ongoing continuing educational workshops on pertinent issues related to peer
support counseling.

Sec. 53.

Minnesota Statutes 2020, section 256B.0616, subdivision 1, is amended to read:


Subdivision 1.

Scope.

Medical assistance covers mental health certified family peer
specialists services, as established in subdivision 2, subject to federal approval, if provided
to recipients who have an emotional disturbance or severe emotional disturbance under
chapter 245, and are provided by a new text begin mental health new text end certified family peer specialist who has
completed the training under subdivision 5new text begin and is qualified according to section 245I.04,
subdivision 12new text end . A family peer specialist cannot provide services to the peer specialist's
family.

Sec. 54.

Minnesota Statutes 2020, section 256B.0616, subdivision 3, is amended to read:


Subd. 3.

Eligibility.

Family peer support services may be deleted text begin located indeleted text end new text begin provided to recipients
ofnew text end inpatient hospitalization, partial hospitalization, residential treatment, new text begin intensive new text end treatment
new text begin in new text end foster care, day treatment, children's therapeutic services and supports, or crisis services.

Sec. 55.

Minnesota Statutes 2020, section 256B.0616, subdivision 5, is amended to read:


Subd. 5.

Certified family peer specialist training and certification.

The commissioner
shall develop a training and certification process for certified family peer specialists deleted text begin who
must be at least 21 years of agedeleted text end . The candidates must have raised or be currently raising a
child with a mental illness, have had experience navigating the children's mental health
system, and must demonstrate leadership and advocacy skills and a strong dedication to
family-driven and family-focused services. The training curriculum must teach participating
family peer specialists specific skills relevant to providing peer support to other parents. In
addition to initial training and certification, the commissioner shall develop ongoing
continuing educational workshops on pertinent issues related to family peer support
counseling.

Sec. 56.

Minnesota Statutes 2020, section 256B.0622, subdivision 1, is amended to read:


Subdivision 1.

Scope.

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

new text begin (b) Subject to federal approval, medical assistance covers medically necessary, intensive
residential treatment services when the services are provided by an entity licensed under
and meeting the standards in section 245I.23.
 new text end

new text begin (c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner, using instruments and protocols approved by the
commissioner.
 new text end

Sec. 57.

Minnesota Statutes 2020, section 256B.0622, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

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

(c) "Assertive community treatment" means intensive nonresidential treatment and
rehabilitative mental health services provided according to the assertive community treatment
model. Assertive community treatment provides a single, fixed point of responsibility for
treatment, rehabilitation, and support needs for clients. Services are offered 24 hours per
day, seven days per week, in a community-based setting.

(d) "Individual treatment plan" means deleted text begin the document that results from a person-centered
planning process of determining real-life outcomes with clients and developing strategies
to achieve those outcomesdeleted text end new text begin a plan described under section 245I.10, subdivisions 7 and 8new text end .

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

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

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

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

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

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

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

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

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

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

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

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

deleted text begin (q) "Overnight staff" means a member of the intensive residential treatment services
team who is responsible during hours when clients are typically asleep.
 deleted text end

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

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

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

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

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

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

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

new text begin (h) "Certified rehabilitation specialist" means a staff person who is qualified according
to section 245I.04, subdivision 8.
 new text end

new text begin (i) "Clinical trainee" means a staff person who is qualified according to section 245I.04,
subdivision 6.
 new text end

new text begin (j) "Mental health certified peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 10.
 new text end

new text begin (k) "Mental health practitioner" means a staff person who is qualified according to section
245I.04, subdivision 4.
 new text end

new text begin (l) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
 new text end

new text begin (m) "Mental health rehabilitation worker" means a staff person who is qualified according
to section 245I.04, subdivision 14.
 new text end

Sec. 58.

Minnesota Statutes 2020, section 256B.0622, subdivision 3a, is amended to read:


Subd. 3a.

Provider certification and contract requirements for assertive community
treatment.

(a) The assertive community treatment provider must:

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

(2) have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section deleted text begin as
well asdeleted text end new text begin , the standards in chapter 245I as required in section 245I.011, subdivision 5, andnew text end
minimum program fidelity standards as measured by a nationally recognized fidelity tool
approved by the commissioner. Recertification must occur at least every three years.

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

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

(2) have adequate administrative ability to ensure availability of services;

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

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

deleted text begin (5)deleted text end new text begin (3)new text end ensure flexibility in service delivery to respond to the changing and intermittent
care needs of a client as identified by the client and the individual treatment plan;

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

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

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

deleted text begin (9)deleted text end new text begin (4)new text end keep all necessary records required by law;

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

deleted text begin (11)deleted text end new text begin (5)new text end be an enrolled Medicaid provider;new text begin and
new text end

deleted text begin (12)deleted text end new text begin (6)new text end establish and maintain a quality assurance plan to determine specific service
outcomes and the client's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end

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

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

Sec. 59.

Minnesota Statutes 2020, section 256B.0622, subdivision 4, is amended to read:


Subd. 4.

Provider entity licensure and contract requirements for intensive residential
treatment services.

deleted text begin (a) The intensive residential treatment services provider entity must:
 deleted text end

deleted text begin (1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;
 deleted text end

deleted text begin (2) not exceed 16 beds per site; and
 deleted text end

deleted text begin (3) comply with the additional standards in this section.
 deleted text end

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

deleted text begin (c)deleted text end new text begin (b)new text end A provider entity must specify in the provider entity's application what geographic
area and populations will be served by the proposed program. A provider entity must
document that the capacity or program specialties of existing programs are not sufficient
to meet the service needs of the target population. A provider entity must submit evidence
of ongoing relationships with other providers and levels of care to facilitate referrals to and
from the proposed program.

deleted text begin (d)deleted text end new text begin (c)new text end A provider entity must submit documentation that the provider entity requested
a statement of need from each county board and tribal authority that serves as a local mental
health authority in the proposed service area. The statement of need must specify if the local
mental health authority supports or does not support the need for the proposed program and
the basis for this determination. If a local mental health authority does not respond within
60 days of the receipt of the request, the commissioner shall determine the need for the
program based on the documentation submitted by the provider entity.

Sec. 60.

Minnesota Statutes 2020, section 256B.0622, subdivision 7, is amended to read:


Subd. 7.

Assertive community treatment service standards.

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

(1) assertive engagementnew text begin using collaborative strategies to encourage clients to receive
servicesnew text end ;

(2) benefits and finance supportnew text begin that assists clients to capably manage financial affairs.
Services include but are not limited to assisting clients in applying for benefits, assisting
with redetermination of benefits, providing financial crisis management, teaching and
supporting budgeting skills and asset development, and coordinating with a client's
representative payee, if applicablenew text end ;

(3) co-occurring new text begin substance use new text end disorder treatmentnew text begin as defined in section 245I.02,
subdivision 11new text end ;

(4) crisis assessment and intervention;

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

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

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

(8) medication assistance and supportnew text begin that assists clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. Medication assistance and support includes assisting the client with the
prescription, administration, and ordering of medication by appropriate medical staffnew text end ;

(9) medication educationnew text begin that educates clients on the role and effects of medications in
treating symptoms of mental illness and the side effects of medicationsnew text end ;

(10) mental health certified peer specialists servicesnew text begin according to section 256B.0615new text end ;

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

(12) rehabilitative mental health servicesnew text begin as defined in section 245I.02, subdivision 33new text end ;

(13) symptom managementnew text begin that supports clients in identifying and targeting the symptoms
and occurrence patterns of their mental illness and developing strategies to reduce the impact
of those symptomsnew text end ;

(14) therapeutic interventionsnew text begin to address specific symptoms and behaviors such as
anxiety, psychotic symptoms, emotional dysregulation, and trauma symptoms. Interventions
include empirically supported psychotherapies including but not limited to cognitive
behavioral therapy, exposure therapy, acceptance and commitment therapy, interpersonal
therapy, and motivational interviewingnew text end ;

(15) wellness self-management and preventionnew text begin that includes a combination of approaches
to working with the client to build and apply skills related to recovery, and to support the
client in participating in leisure and recreational activities, civic participation, and meaningful
structurenew text end ; and

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

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

Sec. 61.

Minnesota Statutes 2020, 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 deleted text begin licenseddeleted text end mental health professional deleted text begin who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item Adeleted text end . 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 deleted text begin clinical
oversightdeleted text end new text begin treatment supervisionnew text end 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 deleted text begin clinical oversightdeleted text end new text begin treatment supervisionnew text end 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 deleted text begin 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 Adeleted text end new text begin mental health
professional permitted to prescribe psychiatric medications as part of the mental health
professional's scope of practicenew text end . 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 deleted text begin clinicaldeleted text end new text begin
treatmentnew text end 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 section 245G.11, subdivision 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) deleted text begin shoulddeleted text end new text begin mustnew text end 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 deleted text begin mental health certified peer specialist as defined in
section 256B.0615deleted text end . 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 deleted text begin licenseddeleted text end
mental health professionals deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item
Adeleted text end ; new text begin clinical trainees; certified rehabilitation specialists; new text end mental health practitioners deleted text begin as defined
in section 245.462, subdivision 17; a mental health practitioner working as a clinical trainee
according to Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end ; or mental health
rehabilitation workers deleted text begin as defined in section 256B.0623, subdivision 5, paragraph (a), clause
(4)deleted text end . 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. 62.

Minnesota Statutes 2020, section 256B.0622, subdivision 7b, is amended to read:


Subd. 7b.

Assertive community treatment program size and opportunities.

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

(1) a small ACT team must:

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

(ii) serve an annual average maximum of no more than 50 clients;

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

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

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

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

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

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

(2) a midsize ACT team shall:

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

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

(iii) serve an annual average maximum caseload of 51 to 74 clients;

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

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

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

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

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

(3) a large ACT team must:

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

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

(iii) serve an annual average maximum caseload of 75 to 100 clients;

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

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

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

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

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

Sec. 63.

Minnesota Statutes 2020, section 256B.0622, subdivision 7c, is amended to read:


Subd. 7c.

Assertive community treatment program organization and communication
requirements.

(a) An ACT team shall provide at least 75 percent of all services in the
community in non-office-based or non-facility-based settings.

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

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

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

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

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

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

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

new text begin (i) The treatment supervision required according to section 245I.06 may include the use
of team supervision. "Team supervision" means the daily team meeting required in paragraph
(g).
 new text end

Sec. 64.

Minnesota Statutes 2020, section 256B.0622, subdivision 7d, is amended to read:


Subd. 7d.

Assertive community treatment assessment and individual treatment
plan.

(a) An initial assessmentdeleted text begin , including a diagnostic assessment that meets the requirements
of Minnesota Rules, part 9505.0372, subpart 1, and a 30-day treatment plandeleted text end shall be
completed the day of the client's admission to assertive community treatment by the ACT
team leader or the psychiatric care provider, with participation by designated ACT team
members and the client. new text begin The initial assessment must include obtaining or completing a
standard diagnostic assessment according to section 245I.10, subdivision 6, and completing
a 30-day individual treatment plan. new text end The team leader, psychiatric care provider, or other
mental health professional designated by the team leader or psychiatric care provider, must
update the client's diagnostic assessment at least annually.

(b) deleted text begin An initialdeleted text end new text begin Anew text end functional assessment must be completed deleted text begin within ten days of intake and
updated every six months for assertive community treatment, or prior to discharge from the
service, whichever comes firstdeleted text end new text begin according to section 245I.10, subdivision 9new text end .

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 65.

Minnesota Statutes 2020, section 256B.0623, subdivision 1, is amended to read:


Subdivision 1.

Scope.

new text begin Subject to federal approval, new text end medical assistance covers new text begin medically
necessary new text end adult rehabilitative mental health services deleted text begin as defined in subdivision 2, subject to
federal approval, if provided to recipients as defined in subdivision 3 and provided by a
qualified provider entity meeting the standards in this section and by a qualified individual
provider working within the provider's scope of practice and identified in the recipient's
individual treatment plan as defined in section 245.462, subdivision 14, and if determined
to be medically necessary according to section 62Q.53deleted text end new text begin when the services are provided by
an entity meeting the standards in this sectionnew text end .new text begin The provider entity must make reasonable
and good faith efforts to report individual client outcomes to the commissioner, using
instruments and protocols approved by the commissioner.
new text end

Sec. 66.

Minnesota Statutes 2020, section 256B.0623, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(a) "Adult rehabilitative mental health services" means deleted text begin mental health services which are
rehabilitative and enable the recipient to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
Adult rehabilitative mental health services are also appropriate when provided to enable a
recipient to retain stability and functioning, if the recipient would be at risk of significant
functional decompensation or more restrictive service settings without these servicesdeleted text end new text begin the
services described in section 245I.02, subdivision 33new text end .

deleted text begin (1) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas such as: interpersonal communication skills, community resource utilization and
integration skills, crisis assistance, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
 deleted text end

deleted text begin (2) These services shall be provided to the recipient on a one-to-one basis in the recipient's
home or another community setting or in groups.
 deleted text end

(b) "Medication education services" means services provided individually or in groups
which focus on educating the recipient about mental illness and symptoms; the role and
effects of medications in treating symptoms of mental illness; and the side effects of
medications. Medication education is coordinated with medication management services
and does not duplicate it. Medication education services are provided by physicians, advanced
practice registered nurses, pharmacists, physician assistants, or registered nurses.

(c) "Transition to community living services" means services which maintain continuity
of contact between the rehabilitation services provider and the recipient and which facilitate
discharge from a hospital, residential treatment program deleted text begin under Minnesota Rules, chapter
9505deleted text end , board and lodging facility, or nursing home. Transition to community living services
are not intended to provide other areas of adult rehabilitative mental health services.

Sec. 67.

Minnesota Statutes 2020, section 256B.0623, subdivision 3, is amended to read:


Subd. 3.

Eligibility.

An eligible recipient is an individual who:

(1) is age 18 or older;

(2) is diagnosed with a medical condition, such as mental illness or traumatic brain
injury, for which adult rehabilitative mental health services are needed;

(3) has substantial disability and functional impairment in three or more of the areas
listed in section deleted text begin 245.462, subdivision 11adeleted text end new text begin 245I.10, subdivision 9, clause (4)new text end , so that
self-sufficiency is markedly reduced; and

(4) has had a recent new text begin standard new text end diagnostic assessment deleted text begin or an adult diagnostic assessment
updatedeleted text end by a qualified professional that documents adult rehabilitative mental health services
are medically necessary to address identified disability and functional impairments and
individual recipient goals.

Sec. 68.

Minnesota Statutes 2020, section 256B.0623, subdivision 4, is amended to read:


Subd. 4.

Provider entity standards.

(a) The provider entity must be certified by the
state following the certification process and procedures developed by the commissioner.

(b) The certification process is a determination as to whether the entity meets the standards
in this deleted text begin subdivisiondeleted text end new text begin section and chapter 245I, as required in section 245I.011, subdivision 5new text end .
The certification must specify which adult rehabilitative mental health services the entity
is qualified to provide.

(c) A noncounty provider entity must obtain additional certification from each county
in which it will provide services. The additional certification must be based on the adequacy
of the entity's knowledge of that county's local health and human service system, and the
ability of the entity to coordinate its services with the other services available in that county.
A county-operated entity must obtain this additional certification from any other county in
which it will provide services.

(d) new text begin State-level new text end recertification must occur at least every three years.

(e) The commissioner may intervene at any time and decertify providers with cause.
The decertification is subject to appeal to the state. A county board may recommend that
the state decertify a provider for cause.

(f) The adult rehabilitative mental health services provider entity must meet the following
standards:

(1) have capacity to recruit, hire, manage, and train deleted text begin mental health professionals, mental
health practitioners, and mental health rehabilitation workersdeleted text end new text begin qualified staffnew text end ;

(2) have adequate administrative ability to ensure availability of services;

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

deleted text begin (4)deleted text end new text begin (3)new text end ensure that deleted text begin mental health professionals, mental health practitioners, and mental
health rehabilitation workersdeleted text end new text begin staffnew text end are skilled in the delivery of the specific adult rehabilitative
mental health services provided to the individual eligible recipient;

deleted text begin (5) ensure that staff is capable of implementing culturally specific services that are
culturally competent and appropriate as determined by the recipient's culture, beliefs, values,
and language as identified in the individual treatment plan;
 deleted text end

deleted text begin (6)deleted text end new text begin (4)new text end ensure enough flexibility in service delivery to respond to the changing and
intermittent care needs of a recipient as identified by the recipient and the individual treatment
plan;

deleted text begin (7) ensure that the mental health professional or mental health practitioner, who is under
the clinical supervision of a mental health professional, involved in a recipient's services
participates in the development of the individual treatment plan;
 deleted text end

deleted text begin (8)deleted text end new text begin (5)new text end assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;

deleted text begin (9)deleted text end new text begin (6)new text end ensure that services are coordinated with other recipient mental health services
providers and the county mental health authority and the federally recognized American
Indian authority and necessary others after obtaining the consent of the recipient. Services
must also be coordinated with the recipient's case manager or care coordinator if the recipient
is receiving case management or care coordination services;

deleted text begin (10) develop and maintain recipient files, individual treatment plans, and contact charting;
 deleted text end

deleted text begin (11) develop and maintain staff training and personnel files;
 deleted text end

deleted text begin (12) submit information as required by the state;
 deleted text end

deleted text begin (13) establish and maintain a quality assurance plan to evaluate the outcome of services
provided;
 deleted text end

deleted text begin (14)deleted text end new text begin (7)new text end keep all necessary records required by law;

deleted text begin (15)deleted text end new text begin (8)new text end deliver services as required by section 245.461;

deleted text begin (16) comply with all applicable laws;
 deleted text end

deleted text begin (17)deleted text end new text begin (9)new text end be an enrolled Medicaid provider;new text begin and
new text end

deleted text begin (18)deleted text end new text begin (10)new text end maintain a quality assurance plan to determine specific service outcomes and
the recipient's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (19) develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
 deleted text end

Sec. 69.

Minnesota Statutes 2020, section 256B.0623, subdivision 5, is amended to read:


Subd. 5.

Qualifications of provider staff.

deleted text begin (a)deleted text end Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified deleted text begin under one of the following criteriadeleted text end new text begin asnew text end :

(1) a mental health professional deleted text begin 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 practitionerdeleted text end new text begin
qualified according to section 245I.04, subdivision 2new text end ;

(2)new text begin a certified rehabilitation specialist qualified according to section 245I.04, subdivision
8;
new text end

new text begin (3) a clinical trainee qualified according to section 245I.04, subdivision 6;
 new text end

new text begin (4)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end new text begin
qualified according to section 245I.04, subdivision 4new text end ;

deleted text begin (3)deleted text end new text begin (5)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end new text begin
qualified according to section 245I.04, subdivision 10new text end ; or

deleted text begin (4)deleted text end new text begin (6)new text end a mental health rehabilitation workernew text begin qualified according to section 245I.04,
subdivision 14new text end . deleted text begin 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:
deleted text end

deleted text begin (i) is at least 21 years of age;
 deleted text end

deleted text begin (ii) has a high school diploma or equivalent;
 deleted text end

deleted text begin (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
 deleted text end

deleted text begin (iv) meets the qualifications in paragraph (b).
 deleted text end

deleted text begin (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):
 deleted text end

deleted text begin (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; is
a registered nurse; or within the previous ten years has:
 deleted text end

deleted text begin (i) three years of personal life experience with serious mental illness;
 deleted text end

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

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

deleted text begin (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;
 deleted text end

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

deleted text begin (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;
 deleted text end

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

deleted text begin (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
 deleted text end

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

deleted text begin (i) satisfies clause (2), items (ii) to (iv); and
 deleted text end

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

deleted text begin (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).
 deleted text end

deleted text begin (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.
 deleted text end

Sec. 70.

Minnesota Statutes 2020, section 256B.0623, subdivision 6, is amended to read:


Subd. 6.

Required deleted text begin training anddeleted text end supervision.

deleted text begin (a) Mental health rehabilitation workers
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services and other areas specific to the population
being served. Mental health rehabilitation workers must also be subject to the ongoing
direction and clinical supervision standards in paragraphs (c) and (d).
 deleted text end

deleted text begin (b) Mental health practitioners must receive ongoing continuing education training as
required by their professional license; or if the practitioner is not licensed, the practitioner
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services. Mental health practitioners must meet
the ongoing clinical supervision standards in paragraph (c).
 deleted text end

deleted text begin (c) Clinical supervision may be provided by a full- or part-time qualified professional
employed by or under contract with the provider entity. Clinical supervision may be provided
by interactive videoconferencing according to procedures developed by the commissioner.
A mental health professional providing clinical supervision of staff delivering adult
rehabilitative mental health services must provide the following guidance:
 deleted text end

deleted text begin (1) review the information in the recipient's file;
 deleted text end

deleted text begin (2) review and approve initial and updates of individual treatment plans;
 deleted text end

new text begin (a) A treatment supervisor providing treatment supervision required under section 245I.06
must:
 new text end

deleted text begin (3)deleted text end new text begin (1)new text end meet with deleted text begin mental health rehabilitation workers and practitioners, individually or
in small groups,deleted text end new text begin staff receiving treatment supervisionnew text end at least monthly to discuss treatment
topics of interest deleted text begin to the workers and practitioners;
deleted text end

deleted text begin (4) meet with mental health rehabilitation workers and practitioners, individually or in
small groups, at least monthly to discussdeleted text end new text begin andnew text end treatment plans of recipientsdeleted text begin , and approve by
signature and document in the recipient's file any resulting plan updatesdeleted text end ;new text begin and
new text end

deleted text begin (5)deleted text end new text begin (2)new text end meet at least monthly with the directing new text begin clinical trainee or new text end mental health
practitioner, if there is one, to review needs of the adult rehabilitative mental health services
program, review staff on-site observations and evaluate mental health rehabilitation workers,
plan staff training, review program evaluation and development, and consult with the
directing new text begin clinical trainee or mental health new text end practitionerdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (6) be available for urgent consultation as the individual recipient needs or the situation
necessitates.
 deleted text end

deleted text begin (d)deleted text end new text begin (b)new text end An adult rehabilitative mental health services provider entity must have a treatment
director who is a deleted text begin mental health practitioner ordeleted text end mental health professionalnew text begin clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end . The treatment director must
deleted text begin ensure the followingdeleted text end :

(1) deleted text begin while delivering direct services to recipients, a newly hired mental health rehabilitation
worker must be directly observed delivering services to recipients by a mental health
practitioner or mental health professional for at least six hours per 40 hours worked during
the first 160 hours that the mental health rehabilitation worker worksdeleted text end new text begin ensure the direct
observation of mental health rehabilitation workers required under section 245I.06,
subdivision 5, is providednew text end ;

deleted text begin (2) the mental health rehabilitation worker must receive ongoing on-site direct service
observation by a mental health professional or mental health practitioner for at least six
hours for every six months of employment;
 deleted text end

deleted text begin (3) progress notes are reviewed from on-site service observation prepared by the mental
health rehabilitation worker and mental health practitioner for accuracy and consistency
with actual recipient contact and the individual treatment plan and goals;
 deleted text end

deleted text begin (4)deleted text end new text begin (2) ensurenew text end immediate availability by phone or in person for consultation by a mental
health professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or a mental health
practitioner to the mental health rehabilitation deleted text begin servicesdeleted text end worker during service provision;

deleted text begin (5) oversee the identification of changes in individual recipient treatment strategies,
revise the plan, and communicate treatment instructions and methodologies as appropriate
to ensure that treatment is implemented correctly;
 deleted text end

deleted text begin (6)deleted text end new text begin (3)new text end model service practices which: respect the recipient, include the recipient in
planning and implementation of the individual treatment plan, recognize the recipient's
strengths, collaborate and coordinate with other involved parties and providers;

deleted text begin (7)deleted text end new text begin (4)new text end ensure that new text begin clinical trainees, new text end mental health practitionersnew text begin ,new text end and mental health
rehabilitation workers are able to effectively communicate with the recipients, significant
others, and providers; and

deleted text begin (8)deleted text end new text begin (5)new text end oversee the record of the results of deleted text begin on-sitedeleted text end new text begin directnew text end observation deleted text begin and chartingdeleted text end new text begin , progress
notenew text end evaluationnew text begin ,new text end and corrective actions taken to modify the work of the new text begin clinical trainees,
new text end mental health practitionersnew text begin ,new text end and mental health rehabilitation workers.

deleted text begin (e)deleted text end new text begin (c)new text end A new text begin clinical trainee or new text end mental health practitioner who is providing treatment direction
for a provider entity must receive new text begin treatment new text end supervision at least monthly deleted text begin from a mental
health professionaldeleted text end to:

(1) identify and plan for general needs of the recipient population served;

(2) identify and plan to address provider entity program needs and effectiveness;

(3) identify and plan provider entity staff training and personnel needs and issues; and

(4) plan, implement, and evaluate provider entity quality improvement programs.

Sec. 71.

Minnesota Statutes 2020, section 256B.0623, subdivision 9, is amended to read:


Subd. 9.

Functional assessment.

new text begin (a) new text end Providers of adult rehabilitative mental health
services must complete a written functional assessment deleted text begin as defined in section 245.462,
subdivision 11adeleted text end new text begin according to section 245I.10, subdivision 9new text end , for each recipient. deleted text begin The functional
assessment must be completed within 30 days of intake, and reviewed and updated at least
every six months after it is developed, unless there is a significant change in the functioning
of the recipient. If there is a significant change in functioning, the assessment must be
updated. A single functional assessment can meet case management and adult rehabilitative
mental health services requirements if agreed to by the recipient. Unless the recipient refuses,
the recipient must have significant participation in the development of the functional
assessment.
deleted text end

new text begin (b) When a provider of adult rehabilitative mental health services completes a written
functional assessment, the provider must also complete a level of care assessment as defined
in section 245I.02, subdivision 19, for the recipient.
 new text end

Sec. 72.

Minnesota Statutes 2020, section 256B.0623, subdivision 12, is amended to read:


Subd. 12.

Additional requirements.

(a) Providers of adult rehabilitative mental health
services must comply with the requirements relating to referrals for case management in
section 245.467, subdivision 4.

(b) Adult rehabilitative mental health services are provided for most recipients in the
recipient's home and community. Services may also be provided at the home of a relative
or significant other, job site, psychosocial clubhouse, drop-in center, social setting, classroom,
or other places in the community. Except for "transition to community services," the place
of service does not include a regional treatment center, nursing home, residential treatment
facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670 (Rule 36)new text begin , or section
245I.23new text end , or an acute care hospital.

(c) Adult rehabilitative mental health services may be provided in group settings if
appropriate to each participating recipient's needs and new text begin individual new text end treatment plan. A group
is defined as two to ten clients, at least one of whom is a recipient, who is concurrently
receiving a service which is identified in this section. The service and group must be specified
in the recipient's new text begin individual new text end treatment plan. No more than two qualified staff may bill
Medicaid for services provided to the same group of recipients. If two adult rehabilitative
mental health workers bill for recipients in the same group session, they must each bill for
different recipients.

new text begin (d) Adult rehabilitative mental health services are appropriate if provided to enable a
recipient to retain stability and functioning, when the recipient is at risk of significant
functional decompensation or requiring more restrictive service settings without these
services.
 new text end

new text begin (e) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas including: interpersonal communication skills, community resource utilization and
integration skills, crisis planning, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
 new text end

new text begin (f) Community intervention, including consultation with relatives, guardians, friends,
employers, treatment providers, and other significant individuals, is appropriate when
directed exclusively to the treatment of the client.
 new text end

Sec. 73.

Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:


Subd. 3b.

Telemedicine services.

(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week, except as provided
in paragraph (f). Telemedicine services shall be paid at the full allowable rate.

(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:

(1) has identified the categories or types of services the health care provider will provide
via telemedicine;

(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;

(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;

(4) has established protocols addressing how and when to discontinue telemedicine
services; and

(5) has an established quality assurance process related to telemedicine services.

(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:

(1) the type of service provided by telemedicine;

(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;

(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;

(5) the location of the originating site and the distant site;

(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and

(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).

(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.

(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, a community paramedic as defined
under section 144E.001, subdivision 5f, deleted text begin ordeleted text end new text begin a clinical trainee qualified according to section
245I.04, subdivision 6,new text end a mental health practitioner deleted text begin defined under section 245.462,
subdivision 17, or 245.4871, subdivision 26, working under the general supervision of a
mental health professionaldeleted text end new text begin qualified according to section 245I.04, subdivision 4new text end , and a
community health worker who meets the criteria under subdivision 49, paragraph (a); "health
care provider" is defined under section 62A.671, subdivision 3; and "originating site" is
defined under section 62A.671, subdivision 7.

(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:

(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and

(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.

Sec. 74.

Minnesota Statutes 2020, section 256B.0625, subdivision 5, is amended to read:


Subd. 5.

Community mental health center services.

Medical assistance covers
community mental health center services provided by a community mental health center
that meets the requirements in paragraphs (a) to (j).

(a) The provider is deleted text begin licensed under Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin
certified as a mental health clinic under section 245I.20new text end .

(b) deleted text begin The provider provides mental health services under the clinical supervision of adeleted text end new text begin The
treatment supervision required by section 245I.06 is provided by anew text end mental health professional
who is licensed for independent practice at the doctoral level or by a board-certified
psychiatrist or a psychiatrist who is eligible for board certification. deleted text begin Clinical supervision has
the meaning given in Minnesota Rules, part 9505.0370, subpart 6.
deleted text end

(c) The provider must be a private nonprofit corporation or a governmental agency and
have a community board of directors as specified by section 245.66.

(d) The provider must have a sliding fee scale that meets the requirements in section
245.481, and agree to serve within the limits of its capacity all individuals residing in its
service delivery area.

(e) At a minimum, the provider must provide the following outpatient mental health
services: diagnostic assessment; explanation of findings; family, group, and individual
psychotherapy, including crisis intervention psychotherapy services, deleted text begin multiple family group
psychotherapydeleted text end , psychological testing, and medication management. In addition, the provider
must provide or be capable of providing upon request of the local mental health authority
day treatment servicesnew text begin , multiple family group psychotherapy,new text end and professional home-based
mental health services. The provider must have the capacity to provide such services to
specialized populations such as the elderly, families with children, persons who are seriously
and persistently mentally ill, and children who are seriously emotionally disturbed.

(f) The provider must be capable of providing the services specified in paragraph (e) to
individuals who are deleted text begin diagnosed with bothdeleted text end new text begin dually diagnosed withnew text end mental illness or emotional
disturbance, and deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end , and to individualsnew text begin who arenew text end
dually diagnosed with a mental illness or emotional disturbance and developmental disability.

(g) The provider must provide 24-hour emergency care services or demonstrate the
capacity to assist recipients in need of such services to access such services on a 24-hour
basis.

(h) The provider must have a contract with the local mental health authority to provide
one or more of the services specified in paragraph (e).

(i) The provider must agree, upon request of the local mental health authority, to enter
into a contract with the county to provide mental health services not reimbursable under
the medical assistance program.

(j) The provider may not be enrolled with the medical assistance program as both a
hospital and a community mental health center. The community mental health center's
administrative, organizational, and financial structure must be separate and distinct from
that of the hospital.

Sec. 75.

Minnesota Statutes 2020, section 256B.0625, subdivision 19c, is amended to
read:


Subd. 19c.

Personal care.

Medical assistance covers personal care assistance services
provided by an individual who is qualified to provide the services according to subdivision
19a and sections 256B.0651 to 256B.0654, provided in accordance with a plan, and
supervised by a qualified professional.

"Qualified professional" means a mental health professional deleted text begin as defined in section 245.462,
subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end ; a registered
nurse as defined in sections 148.171 to 148.285, a licensed social worker as defined in
sections 148E.010 and 148E.055, or a qualified designated coordinator under section
245D.081, subdivision 2. The qualified professional shall perform the duties required in
section 256B.0659.

Sec. 76.

Minnesota Statutes 2020, section 256B.0625, subdivision 28a, is amended to
read:


Subd. 28a.

Licensed physician assistant services.

(a) Medical assistance covers services
performed by a licensed physician assistant if the service is otherwise covered under this
chapter as a physician service and if the service is within the scope of practice of a licensed
physician assistant as defined in section 147A.09.

(b) Licensed physician assistants, who are supervised by a physician certified by the
American Board of Psychiatry and Neurology or eligible for board certification in psychiatry,
may bill for medication management and evaluation and management services provided to
medical assistance enrollees in inpatient hospital settings, and in outpatient settings after
the licensed physician assistant completes 2,000 hours of clinical experience in the evaluation
and treatment of mental health, consistent with their authorized scope of practice, as defined
in section 147A.09, with the exception of performing psychotherapy or diagnostic
assessments or providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision.

Sec. 77.

Minnesota Statutes 2020, section 256B.0625, subdivision 42, is amended to read:


Subd. 42.

Mental health professional.

Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional deleted text begin shall include a person
who isdeleted text end qualified deleted text begin as specified indeleted text end new text begin according tonew text end section deleted text begin 245.462, subdivision 18, clauses (1) to
(6); or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end , for the purpose
of this section and Minnesota Rules, parts 9505.0170 to 9505.0475.

Sec. 78.

Minnesota Statutes 2020, section 256B.0625, subdivision 48, is amended to read:


Subd. 48.

Psychiatric consultation to primary care practitioners.

Medical assistance
covers consultation provided by a deleted text begin psychiatrist, a psychologist, an advanced practice registered
nurse certified in psychiatric mental health, a licensed independent clinical social worker,
as defined in section 245.462, subdivision 18, clause (2), or a licensed marriage and family
therapist, as defined in section 245.462, subdivision 18, clause (5)deleted text end new text begin mental health professional
qualified according to section 245I.04, subdivision 2, except a licensed professional clinical
counselor licensed under section 148B.5301new text end , via telephone, e-mail, facsimile, or other means
of communication to primary care practitioners, including pediatricians. The need for
consultation and the receipt of the consultation must be documented in the patient record
maintained by the primary care practitioner. If the patient consents, and subject to federal
limitations and data privacy provisions, the consultation may be provided without the patient
present.

Sec. 79.

Minnesota Statutes 2020, section 256B.0625, subdivision 49, is amended to read:


Subd. 49.

Community health worker.

(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if the
community health worker hasdeleted text begin :
deleted text end

deleted text begin (1)deleted text end received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculumdeleted text begin ; ordeleted text end new text begin .
new text end

deleted text begin (2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
 deleted text end

deleted text begin Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.
 deleted text end

(b) Community health workers must work under the supervision of a medical assistance
enrolled physician, registered nurse, advanced practice registered nurse, mental health
professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6), and section
245.4871, subdivision 27, clauses (1) to (5)deleted text end , or dentist, or work under the supervision of a
certified public health nurse operating under the direct authority of an enrolled unit of
government.

(c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.

Sec. 80.

Minnesota Statutes 2020, section 256B.0625, subdivision 56a, is amended to
read:


Subd. 56a.

Officer-involved community-based care coordination.

(a) Medical
assistance covers officer-involved community-based care coordination for an individual
who:

(1) has screened positive for benefiting from treatment for a mental illness or substance
use disorder using a tool approved by the commissioner;

(2) does not require the security of a public detention facility and is not considered an
inmate of a public institution as defined in Code of Federal Regulations, title 42, section
435.1010;

(3) meets the eligibility requirements in section 256B.056; and

(4) has agreed to participate in officer-involved community-based care coordination.

(b) Officer-involved community-based care coordination means navigating services to
address a client's mental health, chemical health, social, economic, and housing needs, or
any other activity targeted at reducing the incidence of jail utilization and connecting
individuals with existing covered services available to them, including, but not limited to,
targeted case management, waiver case management, or care coordination.

(c) Officer-involved community-based care coordination must be provided by an
individual who is an employee of or is under contract with a county, or is an employee of
or under contract with an Indian health service facility or facility owned and operated by a
tribe or a tribal organization operating under Public Law 93-638 as a 638 facility to provide
officer-involved community-based care coordination and is qualified under one of the
following criteria:

(1) a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18,
clauses (1) to (6)deleted text end ;

(2)new text begin a clinical trainee qualified according to section 245I.04, subdivision 6, working under
the treatment supervision of a mental health professional according to section 245I.06;
new text end

new text begin (3)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17deleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professionalnew text begin according to section 245I.06new text end ;

deleted text begin (3)deleted text end new text begin (4)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615deleted text end new text begin qualified
according to section 245I.04, subdivision 10new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professionalnew text begin according to section 245I.06new text end ;

(4) an individual qualified as an alcohol and drug counselor under section 245G.11,
subdivision 5; or

(5) a recovery peer qualified under section 245G.11, subdivision 8, working under the
supervision of an individual qualified as an alcohol and drug counselor under section
245G.11, subdivision 5.

(d) Reimbursement is allowed for up to 60 days following the initial determination of
eligibility.

(e) Providers of officer-involved community-based care coordination shall annually
report to the commissioner on the number of individuals served, and number of the
community-based services that were accessed by recipients. The commissioner shall ensure
that services and payments provided under officer-involved community-based care
coordination do not duplicate services or payments provided under section 256B.0625,
subdivision 20, 256B.0753, 256B.0755, or 256B.0757.

(f) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of cost for
officer-involved community-based care coordination services shall be provided by the
county providing the services, from sources other than federal funds or funds used to match
other federal funds.

Sec. 81.

Minnesota Statutes 2020, section 256B.0757, subdivision 4c, is amended to read:


Subd. 4c.

Behavioral health home services staff qualifications.

(a) A behavioral health
home services provider must maintain staff with required professional qualifications
appropriate to the setting.

(b) If behavioral health home services are offered in a mental health setting, the
integration specialist must be a registered nurse licensed under the Minnesota Nurse Practice
Act, sections 148.171 to 148.285.

(c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional deleted text begin as defined indeleted text end new text begin qualified according tonew text end section
deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin
245I.04, subdivision 2new text end .

(d) If behavioral health home services are offered in either a primary care setting or
mental health setting, the systems navigator must be a mental health practitioner deleted text begin as defined
indeleted text end new text begin qualified according tonew text end section deleted text begin 245.462, subdivision 17deleted text end new text begin 245I.04, subdivision 4new text end , or a
community health worker as defined in section 256B.0625, subdivision 49.

(e) If behavioral health home services are offered in either a primary care setting or
mental health setting, the qualified health home specialist must be one of the following:

(1) a new text begin mental health certified new text end peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin qualified according tonew text end
section deleted text begin 256B.0615deleted text end new text begin 245I.04, subdivision 10new text end ;

(2) a new text begin mental health certified new text end family peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin qualified
according tonew text end section deleted text begin 256B.0616deleted text end new text begin 245I.04, subdivision 12new text end ;

(3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);

(4) a mental health rehabilitation worker deleted text begin as defined indeleted text end new text begin qualified according tonew text end section
deleted text begin 256B.0623, subdivision 5, clause (4)deleted text end new text begin 245I.04, subdivision 14new text end ;

(5) a community paramedic as defined in section 144E.28, subdivision 9;

(6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or

(7) a community health worker as defined in section 256B.0625, subdivision 49.

Sec. 82.

Minnesota Statutes 2020, section 256B.0941, subdivision 1, is amended to read:


Subdivision 1.

Eligibility.

(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:

(1) before admission, services are determined to be medically necessary according to
Code of Federal Regulations, title 42, section 441.152;

(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;

(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;

(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;

(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;

(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and

(7) was referred for treatment in a psychiatric residential treatment facility by a deleted text begin qualifieddeleted text end
mental health professional deleted text begin licensed as defined indeleted text end new text begin qualified according tonew text end section deleted text begin 245.4871,
subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .

(b) The commissioner shall provide oversight and review the use of referrals for clients
admitted to psychiatric residential treatment facilities to ensure that eligibility criteria,
clinical services, and treatment planning reflect clinical, state, and federal standards for
psychiatric residential treatment facility level of care. The commissioner shall coordinate
the production of a statewide list of children and youth who meet the medical necessity
criteria for psychiatric residential treatment facility level of care and who are awaiting
admission. The commissioner and any recipient of the list shall not use the statewide list to
direct admission of children and youth to specific facilities.

Sec. 83.

Minnesota Statutes 2020, 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.

deleted text begin (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.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end "Clinical trainee" means a deleted text begin mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin staff person who is qualified
according to section 245I.04, subdivision 6new text end .

deleted text begin (d)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9a. deleted text begin 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.
deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end "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.

deleted text begin (f)deleted text end new text begin (e)new text end "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 deleted text begin multidisciplinarydeleted text end team, under the clinical supervision of a
mental health professional.

deleted text begin (g)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0372, subpart 1deleted text end new text begin means the assessment described in 245I.10, subdivision 6new text end .

deleted text begin (h)deleted text end new text begin (g)new text end "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.

deleted text begin (i)deleted text end new text begin (h)new text end "Direction of mental health behavioral aide" means the activities of a mental
health professionalnew text begin , clinical trainee,new text end 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 deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan and
meet the requirements in subdivision 6, paragraph (b), clause (5).

deleted text begin (j)deleted text end new text begin (i)new text end "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15.

deleted text begin (k)deleted text end new text begin (j)new text end "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional new text begin or a clinical trainee new text end or mental health
practitionerdeleted text begin ,deleted text end under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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.

deleted text begin (l)deleted text end new text begin (k)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0371, subpart 7deleted text end new text begin means the plan described under section 245I.10, subdivisions 7 and
8new text end .

deleted text begin (m)deleted text end new text begin (l)new text end "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a deleted text begin trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3)deleted text end new text begin mental health behavioral aide qualified according to section 245I.04,
subdivision 16new text end , to assist a child retain or generalize psychosocial skills as previously trained
by a mental health professionalnew text begin , clinical trainee,new text end 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).

new text begin (m) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
 new text end

(n) "Mental health practitioner" deleted text begin has the meaning given in section 245.462, subdivision
17, except that a practitioner working in a day treatment setting may qualify as a mental
health practitioner if the practitioner holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or university, and: (1) has at least 2,000
hours of clinically supervised experience in the delivery of mental health services to clients
with mental illness; (2) is fluent in the language, other than English, of the cultural group
that makes up at least 50 percent of the practitioner's clients, completes 40 hours of training
on the delivery of services to clients with mental illness, and receives clinical supervision
from a mental health professional at least once per week until meeting the required 2,000
hours of supervised experience; or (3) receives 40 hours of training on the delivery of
deleted text end deleted text begin services to clients with mental illness within six months of employment, and clinical
supervision from a mental health professional at least once per week until meeting the
required 2,000 hours of supervised experiencedeleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .

(o) "Mental health professional" means deleted text begin an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18deleted text end new text begin a staff person who is qualified according to section 245I.04,
subdivision 2new text end .

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

(1) the development, review, and revision of a child's individual treatment plan, deleted text begin as
provided in Minnesota Rules, part 9505.0371, subpart 7,deleted text end 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 new text begin and reporting the new text end standardized outcome deleted text begin measurement instruments,
determined and updated by the commissionerdeleted text end new text begin measurements in section 245I.10, subdivision
6, paragraph (d), clauses (3) and (4), and other standardized outcome measurements approved
by the commissionernew text end , as periodically needed to evaluate the effectiveness of treatment deleted text begin for
children receiving clinical services and reporting outcome measures, as required by the
commissionerdeleted text end .

(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 deleted text begin 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
plandeleted text end new text begin described in section 256B.0671, subdivision 11new text end .

(s) "Rehabilitative services" or "psychiatric rehabilitation services" means deleted text begin a series or
multidisciplinary combination of psychiatric and psychosocialdeleted text end 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
new text begin coordinated new text end 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. deleted text begin Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
deleted text end

(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).

new text begin (u) "Treatment supervision" means the supervision described in section 245I.06.
 new text end

Sec. 84.

Minnesota Statutes 2020, section 256B.0943, subdivision 2, is amended to read:


Subd. 2.

Covered service components of children's therapeutic services and
supports.

(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports deleted text begin as defined in this section thatdeleted text end new text begin when the services
are provided bynew text end an eligible provider entity certified under deleted text begin subdivision 4 provides to a client
eligible under subdivision 3deleted text end new text begin and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end

(b) The service components of children's therapeutic services and supports are:

(1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis,
and group psychotherapy;

(2) individual, family, or group skills training provided by a mental health professionalnew text begin ,
clinical trainee,new text end or mental health practitioner;

(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end ;

(4) mental health behavioral aide services;

(5) direction of a mental health behavioral aide;

(6) mental health service plan development; and

(7) children's day treatment.

Sec. 85.

Minnesota Statutes 2020, section 256B.0943, subdivision 3, is amended to read:


Subd. 3.

Determination of client eligibility.

new text begin (a) new text end A client's eligibility to receive children's
therapeutic services and supports under this section shall be determined based on a new text begin standard
new text end diagnostic assessment by a mental health professional or a deleted text begin mental health practitioner who
meets the requirements of a clinical trainee as defined in Minnesota Rules, part 9505.0371,
subpart 5, item C,deleted text end new text begin clinical traineenew text end that is performed within one year before the initial start
of service. The new text begin standard new text end diagnostic assessment must deleted text begin meet the requirements for a standard
or extended diagnostic assessment as defined in Minnesota Rules, part 9505.0372, subpart
1, items B and C, anddeleted text end :

deleted text begin (1) include current diagnoses, including any differential diagnosis, in accordance with
all criteria for a complete diagnosis and diagnostic profile as specified in the current edition
of the Diagnostic and Statistical Manual of the American Psychiatric Association, or, for
children under age five, as specified in the current edition of the Diagnostic Classification
of Mental Health Disorders of Infancy and Early Childhood;
 deleted text end

deleted text begin (2)deleted text end new text begin (1)new text end 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;

deleted text begin (3)deleted text end new text begin (2)new text end 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;new text begin and
new text end

deleted text begin (4)deleted text end new text begin (3)new text end be used in the development of the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plandeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (5) be completed annually until age 18. For individuals between age 18 and 21, unless
a client's mental health condition has changed markedly since the client's most recent
diagnostic assessment, annual updating is necessary. For the purpose of this section,
"updating" means an adult diagnostic update as defined in Minnesota Rules, part 9505.0371,
subpart 2, item E.
 deleted text end

new text begin (b) Notwithstanding paragraph (a), 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.
 new text end

Sec. 86.

Minnesota Statutes 2020, section 256B.0943, subdivision 4, is amended to read:


Subd. 4.

Provider entity certification.

(a) The commissioner shall establish an initial
provider entity application and certification process and recertification process to determine
whether a provider entity has an administrative and clinical infrastructure that meets the
requirements in subdivisions 5 and 6. A provider entity must be certified for the three core
rehabilitation services of psychotherapy, skills training, and crisis deleted text begin assistancedeleted text end new text begin planningnew text end . The
commissioner shall recertify a provider entity at least every three years. 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.

(b) For purposes of this section, a provider entity must new text begin meet the standards in this section
and chapter 245I, as required in section 245I.011, subdivision 5, and new text end be:

(1) an Indian health services facility or a facility owned and operated by a tribe or tribal
organization operating as a 638 facility under Public Law 93-638 certified by the state;

(2) a county-operated entity certified by the state; or

(3) a noncounty entity certified by the state.

Sec. 87.

Minnesota Statutes 2020, section 256B.0943, subdivision 5, is amended to read:


Subd. 5.

Provider entity administrative infrastructure requirements.

(a) deleted text begin To be an
eligible provider entity under this section, a provider entity must have an administrative
infrastructure that establishes authority and accountability for decision making and oversight
of functions, including finance, personnel, system management, clinical practice, and
individual treatment outcomes measurement.deleted text end An eligible provider entity shall demonstrate
the availability, by means of employment or contract, of at least one backup mental health
professional in the event of the primary mental health professional's absence. deleted text begin The provider
must have written policies and procedures that it reviews and updates every three years and
distributes to staff initially and upon each subsequent update.
deleted text end

(b) deleted text begin The administrative infrastructure writtendeleted text end new text begin In addition to the policies and procedures
required under section 245I.03, thenew text end policies and procedures must include:

deleted text begin (1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
retention of culturally and linguistically competent providers; (ii) conducting a criminal
background check on all direct service providers and volunteers; (iii) investigating, reporting,
and acting on violations of ethical conduct standards; (iv) investigating, reporting, and acting
on violations of data privacy policies that are compliant with federal and state laws; (v)
utilizing volunteers, including screening applicants, training and supervising volunteers,
and providing liability coverage for volunteers; and (vi) documenting that each mental
health professional, mental health practitioner, or mental health behavioral aide meets the
applicable provider qualification criteria, training criteria under subdivision 8, and clinical
supervision or direction of a mental health behavioral aide requirements under subdivision
6;
 deleted text end

deleted text begin (2)deleted text end new text begin (1)new text end fiscal procedures, including internal fiscal control practices and a process for
collecting revenue that is compliant with federal and state laws;new text begin and
new text end

deleted text begin (3)deleted text end new text begin (2)new text end a client-specific treatment outcomes measurement system, including baseline
measures, to measure a client's progress toward achieving mental health rehabilitation goals.
deleted text begin Effective July 1, 2017, to be eligible for medical assistance payment, a provider entity must
report individual client outcomes to the commissioner, using instruments and protocols
approved by the commissioner; and
deleted text end

deleted text begin (4) a process to establish and maintain individual client records. The client's records
must include:
 deleted text end

deleted text begin (i) the client's personal information;
 deleted text end

deleted text begin (ii) forms applicable to data privacy;
 deleted text end

deleted text begin (iii) the client's diagnostic assessment, updates, results of tests, individual treatment
plan, and individual behavior plan, if necessary;
 deleted text end

deleted text begin (iv) documentation of service delivery as specified under subdivision 6;
 deleted text end

deleted text begin (v) telephone contacts;
 deleted text end

deleted text begin (vi) discharge plan; and
 deleted text end

deleted text begin (vii) if applicable, insurance information.
 deleted text end

(c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.

Sec. 88.

Minnesota Statutes 2020, section 256B.0943, subdivision 5a, is amended to read:


Subd. 5a.

Background studies.

The requirements for background studies under deleted text begin thisdeleted text end
section new text begin 245I.011, subdivision 4, paragraph (d), new text end may be met by a children's therapeutic
services and supports services agency through the commissioner's NETStudy system as
provided under deleted text begin sectionsdeleted text end new text begin sectionnew text end 245C.03, subdivision 7deleted text begin , and 245C.10, subdivision 8deleted text end .

Sec. 89.

Minnesota Statutes 2020, section 256B.0943, subdivision 6, is amended to read:


Subd. 6.

Provider entity clinical infrastructure requirements.

(a) To be an eligible
provider entity under this section, a provider entity must have a clinical infrastructure that
utilizes diagnostic assessment, deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plans, service delivery,
and individual treatment plan review that are culturally competent, child-centered, and
family-driven to achieve maximum benefit for the client. The provider entity must review,
and update as necessary, the clinical policies and procedures every three years, must distribute
the policies and procedures to staff initially and upon each subsequent update, and must
train staff accordingly.

(b) The clinical infrastructure written policies and procedures must include policies and
procedures fornew text begin meeting the requirements in this subdivisionnew text end :

(1) providing or obtaining a client's new text begin standard new text end diagnostic assessment, including a new text begin standard
new text end diagnostic assessment deleted text begin performed by an outside or independent clinician, that identifies acute
and chronic clinical disorders, co-occurring medical conditions, and sources of psychological
and environmental problems, including baselines, and a functional assessment. The functional
assessment component must clearly summarize the client's individual strengths and needs.deleted text end
When required components of the new text begin standard new text end diagnostic assessmentdeleted text begin , such as baseline measures,deleted text end
are not provided in an outside or independent assessment or deleted text begin when baseline measuresdeleted text end cannot
be attained deleted text begin in a one-session standard diagnostic assessmentdeleted text end new text begin immediatelynew text end , the provider entity
must determine the missing information within 30 days and amend the child's new text begin standard
new text end diagnostic assessment or incorporate the deleted text begin baselinesdeleted text end new text begin informationnew text end into the child's individual
treatment plan;

(2) developing an individual treatment plan deleted text begin that:deleted text end new text begin ;
new text end

deleted text begin (i) is based on the information in the client's diagnostic assessment and baselines;
 deleted text end

deleted text begin (ii) identified goals and objectives of treatment, treatment strategy, schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
 deleted text end

deleted text begin (iii) is developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
 deleted text end

deleted text begin (iv) is developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessment, and treatment planning;
 deleted text end

deleted text begin (v) is reviewed at least once every 90 days and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment; and
 deleted text end

deleted text begin (vi) is signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
 deleted text end

(3) developing an individual behavior plan that documents deleted text begin treatment strategiesdeleted text end new text begin and
describes interventionsnew text end to be provided by the mental health behavioral aide. The individual
behavior plan must include:

(i) detailed instructions on the deleted text begin treatment strategies to be provideddeleted text end new text begin psychosocial skills to
be practicednew text end ;

(ii) time allocated to each deleted text begin treatment strategydeleted text end new text begin interventionnew text end ;

(iii) methods of documenting the child's behavior;

(iv) methods of monitoring the child's progress in reaching objectives; and

(v) goals to increase or decrease targeted behavior as identified in the individual treatment
plan;

(4) providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision plans for deleted text begin mental health practitioners and
mental health behavioral aides. A mental health professional must document the clinical
supervision the professional provides by cosigning individual treatment plans and making
entries in the client's record on supervisory activities. The clinical supervisor also shall
document supervisee-specific supervision in the supervisee's personnel file. Clinicaldeleted text end new text begin staff
according to section 245I.06. Treatmentnew text end supervision does not include the authority to make
or terminate court-ordered placements of the child. A deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be
available for urgent consultation as required by the individual client's needs or the situationdeleted text begin .
Clinical supervision may occur individually or in a small group to discuss treatment and
review progress toward goals. The focus of clinical supervision must be the client's treatment
needs and progress and the mental health practitioner's or behavioral aide's ability to provide
servicesdeleted text end ;

(4a) meeting day treatment program conditions in items (i) deleted text begin to (iii)deleted text end new text begin and (ii)new text end :

(i) the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be present and available on the premises more
than 50 percent of the time in a provider's standard working week during which the supervisee
is providing a mental health service;new text begin and
new text end

deleted text begin (ii) the diagnosis and the client's individual treatment plan or a change in the diagnosis
or individual treatment plan must be made by or reviewed, approved, and signed by the
clinical supervisor; and
 deleted text end

deleted text begin (iii)deleted text end new text begin (ii)new text end every 30 days, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must review and sign the record
indicating the supervisor has reviewed the client's care for all activities in the preceding
30-day period;

(4b) meeting the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision standards in items (i) deleted text begin to (iv)deleted text end new text begin and (ii)new text end for
all other services provided under CTSS:

deleted text begin (i) medical assistance shall reimburse for services provided by a mental health practitioner
who is delivering services that fall within the scope of the practitioner's practice and who
is supervised by a mental health professional who accepts full professional responsibility;
 deleted text end

deleted text begin (ii) medical assistance shall reimburse for services provided by a mental health behavioral
aide who is delivering services that fall within the scope of the aide's practice and who is
supervised by a mental health professional who accepts full professional responsibility and
has an approved plan for clinical supervision of the behavioral aide. Plans must be developed
in accordance with supervision standards defined in Minnesota Rules, part 9505.0371,
subpart 4, items A to D;
 deleted text end

deleted text begin (iii)deleted text end new text begin (i)new text end the mental health professional is required to be present at the site of service
delivery for observation as clinically appropriate when the new text begin clinical trainee, new text end mental health
practitionernew text begin ,new text end or mental health behavioral aide is providing CTSS services; and

deleted text begin (iv)deleted text end new text begin (ii)new text end when conducted, the on-site presence of the mental health professional must be
documented in the child's record and signed by the mental health professional who accepts
full professional responsibility;

(5) providing direction to a mental health behavioral aide. For entities that employ mental
health behavioral aides, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be employed by the provider
entity or other provider certified to provide mental health behavioral aide services to ensure
necessary and appropriate oversight for the client's treatment and continuity of care. The
deleted text begin mental health professional or mental health practitionerdeleted text end new text begin staffnew text end giving direction must begin
with the goals on the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan, and instruct the mental health
behavioral aide on how to implement therapeutic activities and interventions that will lead
to goal attainment. The deleted text begin professional or practitionerdeleted text end new text begin staffnew text end giving direction must also instruct
the mental health behavioral aide about the client's diagnosis, functional status, and other
characteristics that are likely to affect service delivery. Direction must also include
determining that the mental health behavioral aide has the skills to interact with the client
and the client's family in ways that convey personal and cultural respect and that the aide
actively solicits information relevant to treatment from the family. The aide must be able
to clearly explain or demonstrate the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision and
requires the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end providing it to continuously evaluate the mental
health behavioral aide's ability to carry out the activities of the deleted text begin individualizeddeleted text end new text begin individualnew text end
treatment plan and the deleted text begin individualizeddeleted text end new text begin individualnew text end behavior plan. When providing direction,
the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end must:

(i) review progress notes prepared by the mental health behavioral aide for accuracy and
consistency with diagnostic assessment, treatment plan, and behavior goals and the
deleted text begin professional or practitionerdeleted text end new text begin staffnew text end must approve and sign the progress notes;

(ii) identify changes in treatment strategies, revise the individual behavior plan, and
communicate treatment instructions and methodologies as appropriate to ensure that treatment
is implemented correctly;

(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;

(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; deleted text begin and
deleted text end

(v) record the results of any evaluation and corrective actions taken to modify the work
of the mental health behavioral aide;new text begin and
new text end

new text begin (vi) ensure the immediate accessibility of a mental health professional, clinical trainee,
or mental health practitioner to the behavioral aide during service delivery;
 new text end

(6) providing service delivery that implements the individual treatment plan and meets
the requirements under subdivision 9; and

(7) individual treatment plan review. The review must determine the extent to which
the services have met each of the goals and objectives in the treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. deleted text begin Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the clinical supervisor and by the client, if appropriate, and by the client's parent
or other person authorized by statute to give consent to the mental health services for the
child.
deleted text end

Sec. 90.

Minnesota Statutes 2020, section 256B.0943, subdivision 7, is amended to read:


Subd. 7.

Qualifications of individual and team providers.

(a) An individual or team
provider working within the scope of the provider's practice or qualifications may provide
service components of children's therapeutic services and supports that are identified as
medically necessary in a client's individual treatment plan.

(b) An individual provider must be qualified asnew text begin anew text end :

(1) deleted text begin adeleted text end mental health professional deleted text begin as defined in subdivision 1, paragraph (o)deleted text end ; deleted text begin or
deleted text end

(2) deleted text begin adeleted text end new text begin clinical trainee;
new text end

new text begin (3)new text end mental health practitioner deleted text begin or clinical trainee. The mental health practitioner or clinical
trainee must work under the clinical supervision of a mental health professionaldeleted text end ; deleted text begin or
deleted text end

new text begin (4) mental health certified family peer specialist; or
 new text end

deleted text begin (3) adeleted text end new text begin (5)new text end mental health behavioral aide deleted text begin working under the clinical supervision of a mental
health professional to implement the rehabilitative mental health services previously
introduced by a mental health professional or practitioner and identified in the client's
individual treatment plan and individual behavior plan.
deleted text end

deleted text begin (A) A level I mental health behavioral aide must:
 deleted text end

deleted text begin (i) be at least 18 years old;
 deleted text end

deleted text begin (ii) have a high school diploma or commissioner of education-selected high school
equivalency certification or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years; and
 deleted text end

deleted text begin (iii) meet preservice and continuing education requirements under subdivision 8.
 deleted text end

deleted text begin (B) A level II mental health behavioral aide must:
 deleted text end

deleted text begin (i) be at least 18 years old;
 deleted text end

deleted text begin (ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents or
complete a certificate program established under subdivision 8a; and
 deleted text end

deleted text begin (iii) meet preservice and continuing education requirements in subdivision 8.
 deleted text end

(c) A day treatment deleted text begin multidisciplinarydeleted text end team must include at least one mental health
professional or clinical trainee and one mental health practitioner.

Sec. 91.

Minnesota Statutes 2020, section 256B.0943, subdivision 9, is amended to read:


Subd. 9.

Service delivery criteria.

(a) In delivering services under this section, a certified
provider entity must ensure that:

(1) deleted text begin each individual provider's caseload size permits the provider to deliver services to
both clients with severe, complex needs and clients with less intensive needs.deleted text end the provider's
caseload size should reasonably enable the provider to play an active role in service planning,
monitoring, and delivering services to meet the client's and client's family's needs, as specified
in each client's individual treatment plan;

(2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and

(3) a day treatment program is provided to a group of clients by a deleted text begin multidisciplinarydeleted text end team
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections 144.50
to 144.55; (ii) a community mental health center under section 245.62; or (iii) an entity that
is certified under subdivision 4 to operate a program that meets the requirements of section
245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day
treatment program must stabilize the client's mental health status while developing and
improving the client's independent living and socialization skills. The goal of the day
treatment program must be to reduce or relieve the effects of mental illness and provide
training to enable the client to live in the community. The program must be available
year-round at least three to five days per week, two or three hours per day, unless the normal
five-day school week is shortened by a holiday, weather-related cancellation, or other
districtwide reduction in a school week. A child transitioning into or out of day treatment
must receive a minimum treatment of one day a week for a two-hour time block. The
two-hour time block must include at least one hour of patient and/or family or group
psychotherapy. The remainder of the structured treatment program may include patient
and/or family or group psychotherapy, and individual or group skills training, if included
in the client's individual treatment plan. Day treatment programs are not part of inpatient
or residential treatment services. When a day treatment group that meets the minimum group
size requirement temporarily falls below the minimum group size because of a member's
temporary absence, medical assistance covers a group session conducted for the group
members in attendance. A day treatment program may provide fewer than the minimally
required hours for a particular child during a billing period in which the child is transitioning
into, or out of, the program.

(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:

(1) deleted text begin patient and/or family, family, and group psychotherapy must be delivered as specified
in Minnesota Rules, part 9505.0372, subpart 6.deleted text end psychotherapy to address the child's
underlying mental health disorder must be documented as part of the child's ongoing
treatment. A provider must deliver, or arrange for, medically necessary psychotherapy,
unless the child's parent or caregiver chooses not to receive it. When a provider delivering
other services to a child under this section deems it not medically necessary to provide
psychotherapy to the child for a period of 90 days or longer, the provider entity must
document the medical reasons why psychotherapy is not necessary. When a provider
determines that a child needs psychotherapy but psychotherapy cannot be delivered due to
a shortage of licensed mental health professionals in the child's community, the provider
must document the lack of access in the child's medical record;

(2) individual, family, or group skills training deleted text begin must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills trainingdeleted text end is subject to the
following requirements:

(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;

(ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;

(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;

(iv) skills training delivered to the child's family must teach skills needed by parents to
enhance the child's skill development, to help the child utilize daily life skills taught by a
mental health professional, clinical trainee, or mental health practitioner, and to develop or
maintain a home environment that supports the child's progressive use of skills;

(v) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:

(A) one mental health professional deleted text begin or onedeleted text end new text begin ,new text end clinical traineenew text begin ,new text end or mental health practitioner
deleted text begin under supervision of a licensed mental health professionaldeleted text end must work with a group of three
to eight clients; or

(B) new text begin any combination of new text end two mental health professionals, deleted text begin twodeleted text end clinical traineesnew text begin ,new text end or mental
health practitioners deleted text begin under supervision of a licensed mental health professional, or one mental
health professional or clinical trainee and one mental health practitionerdeleted text end must work with a
group of nine to 12 clients;

(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and

(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;

(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end to a child and family must include development of a written
plan that anticipates the particular factors specific to the child that may precipitate a
psychiatric crisis for the child in the near future. The written plan must document actions
that the family should be prepared to take to resolve or stabilize a crisis, such as advance
arrangements for direct intervention and support services to the child and the child's family.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end must include preparing resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family when sudden change
in behavior or a loss of usual coping mechanisms is observed, or the child begins to present
a danger to self or others;

(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, deleted text begin which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3),deleted text end and which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:

(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;

(ii) performing as a practice partner or role-play partner;

(iii) reinforcing the child's accomplishments;

(iv) generalizing skill-building activities in the child's multiple natural settings;

(v) assigning further practice activities; and

(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.

To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;new text begin and
new text end

deleted text begin (5) direction of a mental health behavioral aide must include the following:
 deleted text end

deleted text begin (i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child by a mental health professional or mental health practitioner for at least
a total of one hour during every 40 hours of service provided to a child; and
 deleted text end

deleted text begin (ii) immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;
 deleted text end

deleted text begin (6)deleted text end new text begin (5)new text end mental health service plan development must be performed in consultation with
the child's family and, when appropriate, with other key participants in the child's life by
the child's treating mental health professional or clinical trainee or by a mental health
practitioner and approved by the treating mental health professional. Treatment plan drafting
consists of development, review, and revision by face-to-face or electronic communication.
The provider must document events, including the time spent with the family and other key
participants in the child's life to deleted text begin review, revise, and signdeleted text end new text begin approvenew text end the individual treatment
plan. deleted text begin Notwithstanding Minnesota Rules, part 9505.0371, subpart 7,deleted text end Medical assistance
covers service plan development before completion of the child's individual treatment plan.
Service plan development is covered only if a treatment plan is completed for the child. If
upon review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan developmentdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.
 deleted text end

Sec. 92.

Minnesota Statutes 2020, section 256B.0943, subdivision 11, is amended to read:


Subd. 11.

Documentation and billing.

deleted text begin (a)deleted text end A provider entity must document the services
it provides under this section. The provider entity must ensure that documentation complies
with Minnesota Rules, parts 9505.2175 and 9505.2197. Services billed under this section
that are not documented according to this subdivision shall be subject to monetary recovery
by the commissioner. Billing for covered service components under subdivision 2, paragraph
(b), must not include anything other than direct service time.

deleted text begin (b) An individual mental health provider must promptly document the following in a
client's record after providing services to the client:
 deleted text end

deleted text begin (1) each occurrence of the client's mental health service, including the date, type, start
and stop times, scope of the service as described in the child's individual treatment plan,
and outcome of the service compared to baselines and objectives;
 deleted text end

deleted text begin (2) the name, dated signature, and credentials of the person who delivered the service;
 deleted text end

deleted text begin (3) contact made with other persons interested in the client, including representatives
of the courts, corrections systems, or schools. The provider must document the name and
date of each contact;
 deleted text end

deleted text begin (4) any contact made with the client's other mental health providers, case manager,
family members, primary caregiver, legal representative, or the reason the provider did not
contact the client's family members, primary caregiver, or legal representative, if applicable;
 deleted text end

deleted text begin (5) required clinical supervision directly related to the identified client's services and
needs, as appropriate, with co-signatures of the supervisor and supervisee; and
 deleted text end

deleted text begin (6) the date when services are discontinued and reasons for discontinuation of services.
 deleted text end

Sec. 93.

Minnesota Statutes 2020, section 256B.0946, subdivision 1, is amended to read:


Subdivision 1.

Required covered service components.

(a) deleted text begin Effective May 23, 2013,
anddeleted text end Subject to federal approval, medical assistance covers medically necessary intensive
treatment services deleted text begin described under paragraph (b) thatdeleted text end new text begin when the servicesnew text end are provided by a
provider entity deleted text begin eligible under subdivision 3 to a client eligible under subdivision 2 who is
placed in a foster home licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or
placed in a foster home licensed under the regulations established by a federally recognized
Minnesota tribedeleted text end new text begin certified under and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end

(b) Intensive treatment services to children with mental illness residing in foster family
settings that comprise specific required service components provided in clauses (1) to (5)
are reimbursed by medical assistance when they meet the following standards:

(1) psychotherapy provided by a mental health professional deleted text begin as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as defined in Minnesota
Rules, part 9505.0371, subpart 5, item Cdeleted text end ;

(2) crisis deleted text begin assistance provided according to standards for children's therapeutic services
and supports in section 256B.0943deleted text end new text begin planningnew text end ;

(3) individual, family, and group psychoeducation servicesdeleted text begin , defined in subdivision 1a,
paragraph (q),deleted text end provided by a mental health professional or a clinical trainee;

(4) clinical care consultationdeleted text begin , as defined in subdivision 1a, anddeleted text end provided by a mental
health professional or a clinical trainee; and

(5) service delivery payment requirements as provided under subdivision 4.

Sec. 94.

Minnesota Statutes 2020, 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.

deleted text begin (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.
 deleted text end

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

deleted text begin (d)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin has the meaning given in Minnesota Rules, part 9505.0371,
subpart 5, item C;deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end

deleted text begin (e)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9adeleted text begin , 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 interventiondeleted text end .

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

deleted text begin (g)deleted text end new text begin (e)new text end "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.

deleted text begin (h)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 11deleted text end new text begin means the assessment described in section 245I.10, subdivision 6new text end .

deleted text begin (i)deleted text end new text begin (g)new text end "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.

deleted text begin (j)deleted text end new text begin (h)new text end "Foster care" has the meaning given in section 260C.007, subdivision 18.

deleted text begin (k)deleted text end new text begin (i)new text end "Foster family setting" means the foster home in which the license holder resides.

deleted text begin (l)deleted text end new text begin (j)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 15deleted text end new text begin means the plan described in section 245I.04, subdivisions 6 and 7new text end .

deleted text begin (m) "Mental health practitioner" has the meaning given in 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.
 deleted text end

new text begin (k) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
 new text end

deleted text begin (n)deleted text end new text begin (l)new text end "Mental health professional" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 18deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 2new text end .

deleted text begin (o)deleted text end new text begin (m)new text end "Mental illness" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 20deleted text end new text begin section 245I.02, subdivision 29new text end .

deleted text begin (p)deleted text end new text begin (n)new text end "Parent" has the meaning given in section 260C.007, subdivision 25.

deleted text begin (q)deleted text end new text begin (o)new text end "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.

deleted text begin (r)deleted text end new text begin (p)new text end "Psychotherapy" deleted text begin has the meaning given in Minnesota Rules, part 9505.0370,
subpart 27deleted text end new text begin means the treatment described in section 256B.0671, subdivision 11new text end .

deleted text begin (s)deleted text end new text begin (q)new text end "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.

new text begin (r) "Trauma" has the meaning given in section 245I.02, subdivision 38.
 new text end

new text begin (s) "Treatment supervision" means the supervision described under section 245I.06.
 new text end

Sec. 95.

Minnesota Statutes 2020, section 256B.0946, subdivision 2, is amended to read:


Subd. 2.

Determination of client eligibility.

An eligible recipient is an individual, from
birth through age 20, who is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, new text begin or placed in a foster home licensed under the
regulations established by a federally recognized Minnesota tribe, new text end and has receivednew text begin : (1)new text end a
new text begin standard new text end diagnostic assessment deleted text begin and an evaluation of level of care needed, as defined in
paragraphs (a) and (b).deleted text end new text begin within 180 days before the start of service that documents that
intensive treatment services are medically necessary within a foster family setting to
ameliorate identified symptoms and functional impairments; and (2) a level of care
assessment as defined in section 245I.02, subdivision 19, that demonstrates that the individual
requires intensive intervention without 24-hour medical monitoring, and a functional
assessment as defined in section 245I.02, subdivision 17. The level of care assessment and
the functional assessment must include information gathered from the placing county, tribe,
or case manager.
new text end

deleted text begin (a) The diagnostic assessment must:
 deleted text end

deleted text begin (1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
conducted by a mental health professional or a clinical trainee;
 deleted text end

deleted text begin (2) determine whether or not a child meets the criteria for mental illness, as defined in
Minnesota Rules, part 9505.0370, subpart 20;
 deleted text end

deleted text begin (3) document that intensive treatment services are medically necessary within a foster
family setting to ameliorate identified symptoms and functional impairments;
 deleted text end

deleted text begin (4) be performed within 180 days before the start of service; and
 deleted text end

deleted text begin (5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
 deleted text end

deleted text begin (b) The evaluation of level of care must be conducted by the placing county, tribe, or
case manager in conjunction with the diagnostic assessment as described by Minnesota
Rules, part 9505.0372, subpart 1, item B, using a validated tool approved by the
commissioner of human services and not subject to the rulemaking process, consistent with
section 245.4885, subdivision 1, paragraph (d), the result of which evaluation demonstrates
that the child requires intensive intervention without 24-hour medical monitoring. The
commissioner shall update the list of approved level of care tools annually and publish on
the department's website.
 deleted text end

Sec. 96.

Minnesota Statutes 2020, section 256B.0946, subdivision 3, is amended to read:


Subd. 3.

Eligible mental health services providers.

(a) Eligible providers for intensive
children's mental health services in a foster family setting must be certified by the state and
have a service provision contract with a county board or a reservation tribal council and
must be able to demonstrate the ability to provide all of the services required in this sectionnew text begin
and meet the standards in chapter 245I, as required in section 245I.011, subdivision 5new text end .

(b) For purposes of this section, a provider agency must be:

(1) a county-operated entity certified by the state;

(2) an Indian Health Services facility operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or

(3) a noncounty entity.

(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.

(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional or a clinical trainee.

Sec. 97.

Minnesota Statutes 2020, section 256B.0946, subdivision 4, is amended to read:


Subd. 4.

Service delivery payment requirements.

(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment in foster care, consistent with subdivision 1, paragraph (b), and comply
with the following requirements in paragraphs (b) to deleted text begin (n)deleted text end new text begin (l)new text end .

deleted text begin (b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.
 deleted text end

deleted text begin (c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
 deleted text end

deleted text begin (d)deleted text end new text begin (b)new text end Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
new text begin standard new text end diagnostic assessment and team consultation and treatment planning review process.

deleted text begin (e)deleted text end new text begin (c)new text end Each client receiving treatment must be assessed for a trauma history, and the
client's treatment plan must document how the results of the assessment will be incorporated
into treatment.

new text begin (d) The level of care assessment as defined in section 245I.02, subdivision 19, and
functional assessment as defined in section 245I.02, subdivision 17, must be updated at
least every 90 days or prior to discharge from the service, whichever comes first.
 new text end

deleted text begin (f)deleted text end new text begin (e)new text end Each client receiving treatment services must have an individual treatment plan
that is reviewed, evaluated, and deleted text begin signeddeleted text end new text begin approvednew text end every 90 days using the team consultation
and treatment planning processdeleted text begin , as defined in subdivision 1a, paragraph (s)deleted text end .

deleted text begin (g)deleted text end new text begin (f) Clinicalnew text end care consultationdeleted text begin , as defined in subdivision 1a, paragraph (a),deleted text end must be
provided in accordance with the client's individual treatment plan.

deleted text begin (h)deleted text end new text begin (g)new text end Each client must have a crisis deleted text begin assistancedeleted text end plan within ten days of initiating services
and must have access to clinical phone support 24 hours per day, seven days per week,
during the course of treatment. The crisis plan must demonstrate coordination with the local
or regional mobile crisis intervention team.

deleted text begin (i)deleted text end new text begin (h)new text end Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week, unless reduced units of service are specified on the
treatment plan as part of transition or on a discharge plan to another service or level of care.
deleted text begin Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
deleted text end

deleted text begin (j)deleted text end new text begin (i)new text end Location of service delivery must be in the client's home, day care setting, school,
or other community-based setting that is specified on the client's individualized treatment
plan.

deleted text begin (k)deleted text end new text begin (j)new text end Treatment must be developmentally and culturally appropriate for the client.

deleted text begin (l)deleted text end new text begin (k)new text end Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the service team must be aware
of the medication regimen and potential side effects.

deleted text begin (m)deleted text end new text begin (l)new text end Parents, siblings, foster parents, and members of the child's permanency plan
must be involved in treatment and service delivery unless otherwise noted in the treatment
plan.

deleted text begin (n)deleted text end new text begin (m)new text end Transition planning for the child must be conducted starting with the first
treatment plan and must be addressed throughout treatment to support the child's permanency
plan and postdischarge mental health service needs.

Sec. 98.

Minnesota Statutes 2020, section 256B.0946, subdivision 6, is amended to read:


Subd. 6.

Excluded services.

(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of intensive
treatment in foster care services, but may be billed separately:

(1) inpatient psychiatric hospital treatment;

(2) mental health targeted case management;

(3) partial hospitalization;

(4) medication management;

(5) children's mental health day treatment services;

(6) crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ; deleted text begin and
deleted text end

(7) transportationdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (8) mental health certified family peer specialist services under section 256B.0616.
 new text end

(b) Children receiving intensive treatment in foster care services are not eligible for
medical assistance reimbursement for the following services while receiving intensive
treatment in foster care:

(1) psychotherapy and skills training components of children's therapeutic services and
supports under section deleted text begin 256B.0625, subdivision 35bdeleted text end new text begin 256B.0943new text end ;

(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end ;

(3) home and community-based waiver services;

(4) mental health residential treatment; and

(5) room and board costs as defined in section 256I.03, subdivision 6.

Sec. 99.

Minnesota Statutes 2020, section 256B.0947, subdivision 1, is amended to read:


Subdivision 1.

Scope.

deleted text begin Effective November 1, 2011, anddeleted text end Subject to federal approval,
medical assistance covers medically necessary, intensive nonresidential rehabilitative mental
health services deleted text begin as defined in subdivision 2, for recipients as defined in subdivision 3,deleted text end when
the services are provided by an entity meeting the standards in this section.new text begin The provider
entity must make reasonable and good faith efforts to report individual client outcomes to
the commissioner, using instruments and protocols approved by the commissioner.
new text end

Sec. 100.

Minnesota Statutes 2020, section 256B.0947, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

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

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

(c) "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given to it in Minnesota Rules,
part 9505.0370, subpart 11. A diagnostic assessment must be provided according to
Minnesota Rules, part 9505.0372, subpart 1, and for this section must incorporate a
determination of the youth's necessary level of care using a standardized functional
assessment instrument approved and periodically updated by the commissionerdeleted text end new text begin means the
assessment described in section 245I.10, subdivision 6new text end .

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

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

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

deleted text begin (g)deleted text end new text begin (d)new text end "Medication education services" means services provided individually or in
groups, which focus on:

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

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

(3) the side effects of medications.

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

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

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

deleted text begin (2) assists younger peers to identify and achieve specific life goals;
 deleted text end

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

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

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

deleted text begin (6) meets the following criteria:
 deleted text end

deleted text begin (i) is at least 22 years of age;
 deleted text end

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

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

deleted text begin (iv) has at least a high school diploma or equivalent;
 deleted text end

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

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

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

new text begin (e) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
 new text end

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

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

deleted text begin (k)deleted text end new text begin (h)new text end "Transition services" means:

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

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

(3) establishing communication between sending and receiving entities;

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

(5) establishing and enforcing procedures and schedules.

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

deleted text begin (l)deleted text end new text begin (i)new text end "Treatment team" means all staff who provide services to recipients under this
section.

deleted text begin (m)deleted text end new text begin (j)new text end "Family peer specialist" means a staff person new text begin who is new text end qualified under section
256B.0616.

Sec. 101.

Minnesota Statutes 2020, section 256B.0947, subdivision 3, is amended to read:


Subd. 3.

Client eligibility.

An eligible recipient is an individual who:

(1) is age 16, 17, 18, 19, or 20; and

(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
deleted text begin abuse addictiondeleted text end new text begin use disordernew text end , for which intensive nonresidential rehabilitative mental health
services are needed;

(3) has received a deleted text begin level-of-care determination, using an instrument approved by the
commissionerdeleted text end new text begin level of care assessment as defined in section 245I.02, subdivision 19new text end , that
indicates a need for intensive integrated intervention without 24-hour medical monitoring
and a need for extensive collaboration among multiple providers;

(4) hasnew text begin receivednew text end anew text begin functional assessment as defined in section 245I.02, subdivision 17,
that indicatesnew text end functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system within the next two years; and

(5) has had a recent new text begin standard new text end diagnostic assessmentdeleted text begin , as provided in Minnesota Rules,
part 9505.0372, subpart 1, by a mental health professional who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to ameliorate identified
symptoms and functional impairments and to achieve individual transition goals.

Sec. 102.

Minnesota Statutes 2020, section 256B.0947, subdivision 3a, is amended to
read:


Subd. 3a.

Required service components.

deleted text begin (a) Subject to federal approval, medical
assistance covers all medically necessary intensive nonresidential rehabilitative mental
health services and supports, as defined in this section, under a single daily rate per client.
Services and supports must be delivered by an eligible provider under subdivision 5 to an
eligible client under subdivision 3.
 deleted text end

deleted text begin (b)deleted text end new text begin (a)new text end Intensive nonresidential rehabilitative mental health services, supports, and
ancillary activities new text begin are new text end covered by deleted text begin thedeleted text end new text begin anew text end single daily rate per client must include the following,
as needed by the individual client:

(1) individual, family, and group psychotherapy;

(2) individual, family, and group skills training, as defined in section 256B.0943,
subdivision 1, paragraph (t);

(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end as defined in section 245.4871, subdivision 9adeleted text begin , which
includes recognition of factors precipitating a mental health crisis, identification of behaviors
related to the crisis, and the development of a plan to address prevention, intervention, and
follow-up strategies to be used in the lead-up to or onset of, and conclusion of, a mental
health crisis; crisis assistance does not mean crisis response services or crisis intervention
services provided in section 256B.0944deleted text end ;

(4) medication management provided by a physician or an advanced practice registered
nurse with certification in psychiatric and mental health care;

(5) mental health case management as provided in section 256B.0625, subdivision 20;

(6) medication education services as defined in this section;

(7) care coordination by a client-specific lead worker assigned by and responsible to the
treatment team;

(8) psychoeducation of and consultation and coordination with the client's biological,
adoptive, or foster family and, in the case of a youth living independently, the client's
immediate nonfamilial support network;

(9) clinical consultation to a client's employer or school or to other service agencies or
to the courts to assist in managing the mental illness or co-occurring disorder and to develop
client support systems;

(10) coordination with, or performance of, crisis intervention and stabilization services
as defined in section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ;

deleted text begin (11) assessment of a client's treatment progress and effectiveness of services using
standardized outcome measures published by the commissioner;
 deleted text end

deleted text begin (12)deleted text end new text begin (11)new text end transition services deleted text begin as defined in this sectiondeleted text end ;

deleted text begin (13) integrated dual disorders treatment as defined in this sectiondeleted text end new text begin (12) co-occurring
substance use disorder treatment as defined in section 245I.02, subdivision 11new text end ; and

deleted text begin (14)deleted text end new text begin (13)new text end housing access supportnew text begin that assists clients to find, obtain, retain, and move to
safe and adequate housing. Housing access support does not provide monetary assistance
for rent, damage deposits, or application feesnew text end .

deleted text begin (c)deleted text end new text begin (b)new text end The provider shall ensure and document the following by means of performing
the required function or by contracting with a qualified person or entity:

deleted text begin (1)deleted text end client access to crisis intervention services, as defined in section deleted text begin 256B.0944deleted text end new text begin
256B.0624new text end , and available 24 hours per day and seven days per weekdeleted text begin ;deleted text end new text begin .
new text end

deleted text begin (2) completion of an extended diagnostic assessment, as defined in Minnesota Rules,
part 9505.0372, subpart 1, item C; and
 deleted text end

deleted text begin (3) determination of the client's needed level of care using an instrument approved and
periodically updated by the commissioner.
 deleted text end

Sec. 103.

Minnesota Statutes 2020, section 256B.0947, subdivision 5, is amended to read:


Subd. 5.

Standards for intensive nonresidential rehabilitative providers.

(a) Services
must deleted text begin be provided by a provider entity as provided in subdivision 4deleted text end new text begin meet the standards in
this section and chapter 245I as required in section 245I.011, subdivision 5new text end .

(b) 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) deleted text begin The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical responsibility
for clients.deleted text end 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 new text begin minimally new text end includedeleted text begin , but is not limited todeleted text end :

(i) deleted text begin an independently licenseddeleted text end new text begin anew text end mental health professionaldeleted text begin , qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end who serves as team leader to provide administrative
direction and deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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;

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

(iv) a new text begin mental health certified new text end peer specialist deleted text begin as defined in subdivision 2, paragraph (h)deleted text end new text begin
who is qualified according to section 245I.04, subdivision 10, and is also a former children's
mental health consumernew 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 specialistnew text begin with knowledge and experience working with youth
regarding special education requirements and goals, special education plans, and coordination
of educational activities with health care activitiesnew text end ;

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

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

new text begin (vi)new text end a mental health practitionerdeleted text begin , as defined in section 245.4871, subdivision 26deleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end ;

deleted text begin (vi)deleted text end new text begin (vii)new text end a case management service provider, as defined in section 245.4871, subdivision
4;

deleted text begin (vii)deleted text end new text begin (viii)new text end a housing access specialist; and

deleted text begin (viii)deleted text end new text begin (ix)new text end a family peer specialist as defined in subdivision 2, paragraph (m).

(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 deleted text begin abusedeleted text end new text begin usenew text end 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.

(c) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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 deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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.

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

(e) 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.

(f) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitionernew text begin , clinical trainee,new text end 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.

(g) 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.

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

Sec. 104.

Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:


Subd. 6.

Service standards.

The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.

(a) The treatment team must use team treatment, not an individual treatment model.

(b) Services must be available at times that meet client needs.

(c) Services must be age-appropriate and meet the specific needs of the client.

(d) The deleted text begin initial functional assessment must be completed within ten days of intake anddeleted text end new text begin
level of care assessment as defined in section 245I.02, subdivision 19, and functional
assessment as defined in section 245I.02, subdivision 17, must benew text end updated at least every deleted text begin six
monthsdeleted text end new text begin 90 days new text end or prior to discharge from the service, whichever comes first.

(e) An individual treatment plan mustnew text begin be completed for each client, according to section
245I.10, subdivisions 7 and 8, and, additionally, mustnew text end :

deleted text begin (1) be based on the information in the client's diagnostic assessment and baselines;
 deleted text end

deleted text begin (2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
 deleted text end

deleted text begin (3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
 deleted text end

deleted text begin (4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
 deleted text end

deleted text begin (5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
 deleted text end

deleted text begin (6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
 deleted text end

deleted text begin (7)deleted text end new text begin (1)new text end be completed in consultation with the client's current therapist and key providers
and provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;

deleted text begin (8)deleted text end new text begin (2)new text end if a need for substance use disorder treatment is indicated by validated assessment:

(i) identify goals, objectives, and strategies of substance use disorder treatment;

new text begin (ii)new text end develop a schedule for accomplishingnew text begin substance use disordernew text end treatment goals and
objectives; and

new text begin (iii)new text end identify the individuals responsible for providingnew text begin substance use disordernew text end treatment
services and supports;

deleted text begin (ii) be reviewed at least once every 90 days and revised, if necessary;
 deleted text end

deleted text begin (9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
 deleted text end

deleted text begin (10)deleted text end new text begin (3)new text end provide for the client's transition out of intensive nonresidential rehabilitative
mental health services by defining the team's actions to assist the client and subsequent
providers in the transition to less intensive or "stepped down" servicesdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (4) notwithstanding section 245I.10, subdivision 8, be reviewed at least every 90 days
and revised to document treatment progress or, if progress is not documented, to document
changes in treatment.
 new text end

(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.

(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.

(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.

Sec. 105.

Minnesota Statutes 2020, section 256B.0947, subdivision 7, is amended to read:


Subd. 7.

Medical assistance payment and rate setting.

(a) Payment for services in this
section must be based on one daily encounter rate per provider inclusive of the following
services received by an eligible client in a given calendar day: all rehabilitative services,
supports, and ancillary activities under this section, staff travel time to provide rehabilitative
services under this section, and crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end .

(b) Payment must not be made to more than one entity for each client for services
provided under this section on a given day. If services under this section are provided by a
team that includes staff from more than one entity, the team shall determine how to distribute
the payment among the members.

(c) The commissioner shall establish regional cost-based rates for entities that will bill
medical assistance for nonresidential intensive rehabilitative mental health services. In
developing these rates, the commissioner shall consider:

(1) the cost for similar services in the health care trade area;

(2) actual costs incurred by entities providing the services;

(3) the intensity and frequency of services to be provided to each client;

(4) the degree to which clients will receive services other than services under this section;
and

(5) the costs of other services that will be separately reimbursed.

(d) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers.

Sec. 106.

Minnesota Statutes 2020, section 256B.0949, subdivision 2, is amended to read:


Subd. 2.

Definitions.

(a) The terms used in this section have the meanings given in this
subdivision.

(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.

(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:

(1) is severe and chronic;

(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;

(3) requires treatment or services similar to those required for a person with ASD; and

(4) results in substantial functional limitations in three core developmental deficits of
ASD: social or interpersonal interaction; functional communication, including nonverbal
or social communication; and restrictive or repetitive behaviors or hyperreactivity or
hyporeactivity to sensory input; and may include deficits or a high level of support in one
or more of the following domains:

(i) behavioral challenges and self-regulation;

(ii) cognition;

(iii) learning and play;

(iv) self-care; or

(v) safety.

(d) "Person" means a person under 21 years of age.

(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.

(f) "Commissioner" means the commissioner of human services, unless otherwise
specified.

(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.

(h) "Department" means the Department of Human Services, unless otherwise specified.

(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means a variety of individualized, intensive treatment modalities approved and
published by the commissioner that are based in behavioral and developmental science
consistent with best practices on effectiveness.

(j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and people, and in different environments including, but not limited to, clinics, homes,
schools, and the community.

(k) "Incident" means when any of the following occur:

(1) an illness, accident, or injury that requires first aid treatment;

(2) a bump or blow to the head; or

(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.

(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.

(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.

(n) "Mental health professional" deleted text begin has the meaning given indeleted text end new text begin means a staff person who is
qualified according tonew text end section deleted text begin 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04,
subdivision 2new text end .

(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.

(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.

Sec. 107.

Minnesota Statutes 2020, section 256B.0949, subdivision 4, is amended to read:


Subd. 4.

Diagnosis.

(a) A diagnosis of ASD or a related condition must:

(1) be based upon current DSM criteria including direct observations of the person and
information from the person's legal representative or primary caregivers;

(2) be completed by either (i) a licensed physician or advanced practice registered nurse
or (ii) a mental health professional; and

(3) meet the requirements of deleted text begin Minnesota Rules, part 9505.0372, subpart 1, items B and
Cdeleted text end new text begin a standard diagnostic assessment according to section 245I.10, subdivision 6new text end .

(b) Additional assessment information may be considered to complete a diagnostic
assessment including specialized tests administered through special education evaluations
and licensed school personnel, and from professionals licensed in the fields of medicine,
speech and language, psychology, occupational therapy, and physical therapy. A diagnostic
assessment may include treatment recommendations.

Sec. 108.

Minnesota Statutes 2020, section 256B.0949, subdivision 5a, is amended to
read:


Subd. 5a.

Comprehensive multidisciplinary evaluation provider qualification.

A
CMDE provider must:

(1) be a licensed physician, advanced practice registered nurse, a mental health
professional, or a deleted text begin mental health practitioner who meets the requirements of adeleted text end clinical trainee
deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin who is qualified according
to section 245I.04, subdivision 6new text end ;

(2) have at least 2,000 hours of clinical experience in the evaluation and treatment of
people with ASD or a related condition or equivalent documented coursework at the graduate
level by an accredited university in the following content areas: ASD or a related condition
diagnosis, ASD or a related condition treatment strategies, and child development; and

(3) be able to diagnose, evaluate, or provide treatment within the provider's scope of
practice and professional license.

Sec. 109.

Minnesota Statutes 2020, section 256B.25, subdivision 3, is amended to read:


Subd. 3.

Payment exceptions.

The limitation in subdivision 2 shall not apply to:

(1) payment of Minnesota supplemental assistance funds to recipients who reside in
facilities which are involved in litigation contesting their designation as an institution for
treatment of mental disease;

(2) payment or grants to a boarding care home or supervised living facility licensed by
the Department of Human Services under Minnesota Rules, parts 2960.0130 to 2960.0220
deleted text begin ordeleted text end new text begin ,new text end 2960.0580 to 2960.0700,new text begin ornew text end 9520.0500 to 9520.0670, or new text begin under new text end chapter 245Gnew text begin or 245Inew text end ,
or payment to recipients who reside in these facilities;

(3) payments or grants to a boarding care home or supervised living facility which are
ineligible for certification under United States Code, title 42, sections 1396-1396p;

(4) payments or grants otherwise specifically authorized by statute or rule.

Sec. 110.

Minnesota Statutes 2020, section 256B.761, is amended to read:


256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.

deleted text begin (c) The commissioner shall establish three levels of payment for mental health diagnostic
assessment, based on three levels of complexity. The aggregate payment under the tiered
rates must not exceed the projected aggregate payments for mental health diagnostic
assessment under the previous single rate. The new rate structure is effective January 1,
2011, or upon federal approval, whichever is later.
 deleted text end

deleted text begin (d)deleted text end new text begin (c)new text end In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.

deleted text begin (e)deleted text end new text begin (d)new text end Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

Sec. 111.

Minnesota Statutes 2020, section 256B.763, is amended to read:


256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.

(a) For services defined in paragraph (b) and rendered on or after July 1, 2007, payment
rates shall be increased by 23.7 percent over the rates in effect on January 1, 2006, for:

(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;

(2) community mental health centers under section 256B.0625, subdivision 5; and

(3) mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin section 245I.20new text end , or hospital outpatient psychiatric departments that are
designated as essential community providers under section 62Q.19.

(b) This increase applies to group skills training when provided as a component of
children's therapeutic services and support, psychotherapy, medication management,
evaluation and management, diagnostic assessment, explanation of findings, psychological
testing, neuropsychological services, direction of behavioral aides, and inpatient consultation.

(c) This increase does not apply to rates that are governed by section 256B.0625,
subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are negotiated
with the county, rates that are established by the federal government, or rates that increased
between January 1, 2004, and January 1, 2005.

(d) The commissioner shall adjust rates paid to prepaid health plans under contract with
the commissioner to reflect the rate increases provided in paragraphs (a), (e), and (f). The
prepaid health plan must pass this rate increase to the providers identified in paragraphs (a),
(e), (f), and (g).

(e) Payment rates shall be increased by 23.7 percent over the rates in effect on December
31, 2007, for:

(1) medication education services provided on or after January 1, 2008, by adult
rehabilitative mental health services providers certified under section 256B.0623; and

(2) mental health behavioral aide services provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.

(f) For services defined in paragraph (b) and rendered on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943 and
not already included in paragraph (a), payment rates shall be increased by 23.7 percent over
the rates in effect on December 31, 2007.

(g) Payment rates shall be increased by 2.3 percent over the rates in effect on December
31, 2007, for individual and family skills training provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.

(h) For services described in paragraphs (b), (e), and (g) and rendered on or after July
1, 2017, payment rates for mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules,
parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end , that are not designated as essential community
providers under section 62Q.19 shall be equal to payment rates for mental health clinics
deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end ,
that are designated as essential community providers under section 62Q.19. In order to
receive increased payment rates under this paragraph, a provider must demonstrate a
commitment to serve low-income and underserved populations by:

(1) charging for services on a sliding-fee schedule based on current poverty income
guidelines; and

(2) not restricting access or services because of a client's financial limitation.

Sec. 112.

Minnesota Statutes 2020, section 256P.01, subdivision 6a, is amended to read:


Subd. 6a.

Qualified professional.

(a) For illness, injury, or incapacity, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, physical therapist, occupational therapist, or licensed chiropractor, according to their
scope of practice.

(b) For developmental disability, learning disability, and intelligence testing, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, licensed independent clinical social worker, licensed psychologist, certified school
psychologist, or certified psychometrist working under the supervision of a licensed
psychologist.

(c) For mental health, a "qualified professional" means a licensed physician, advanced
practice registered nurse, or qualified mental health professional under section deleted text begin 245.462,
subdivision 18, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .

(d) For substance use disorder, a "qualified professional" means a licensed physician, a
qualified mental health professional under section 245.462, subdivision 18, clauses (1) to
(6), or an individual as defined in section 245G.11, subdivision 3, 4, or 5.

Sec. 113.

Minnesota Statutes 2020, section 295.50, subdivision 9b, is amended to read:


Subd. 9b.

Patient services.

(a) "Patient services" means inpatient and outpatient services
and other goods and services provided by hospitals, surgical centers, or health care providers.
They include the following health care goods and services provided to a patient or consumer:

(1) bed and board;

(2) nursing services and other related services;

(3) use of hospitals, surgical centers, or health care provider facilities;

(4) medical social services;

(5) drugs, biologicals, supplies, appliances, and equipment;

(6) other diagnostic or therapeutic items or services;

(7) medical or surgical services;

(8) items and services furnished to ambulatory patients not requiring emergency care;
and

(9) emergency services.

(b) "Patient services" does not include:

(1) services provided to nursing homes licensed under chapter 144A;

(2) examinations for purposes of utilization reviews, insurance claims or eligibility,
litigation, and employment, including reviews of medical records for those purposes;

(3) services provided to and by community residential mental health facilities licensed
under new text begin section 245I.23 or new text end Minnesota Rules, parts 9520.0500 to 9520.0670, and to and by
residential treatment programs for children with severe emotional disturbance licensed or
certified under chapter 245A;

(4) services provided under the following programs: day treatment services as defined
in section 245.462, subdivision 8; assertive community treatment as described in section
256B.0622; adult rehabilitative mental health services as described in section 256B.0623;
deleted text begin adultdeleted text end crisis response services as described in section 256B.0624; new text begin and new text end children's therapeutic
services and supports as described in section 256B.0943; deleted text begin and children's mental health crisis
response services as described in section 256B.0944;
deleted text end

(5) services provided to and by community mental health centers as defined in section
245.62, subdivision 2;

(6) services provided to and by assisted living programs and congregate housing
programs;

(7) hospice care services;

(8) home and community-based waivered services under chapter 256S and sections
256B.49 and 256B.501;

(9) targeted case management services under sections 256B.0621; 256B.0625,
subdivisions 20, 20a, 33, and 44; and 256B.094; and

(10) services provided to the following: supervised living facilities for persons with
developmental disabilities licensed under Minnesota Rules, parts 4665.0100 to 4665.9900;
housing with services establishments required to be registered under chapter 144D; board
and lodging establishments providing only custodial services that are licensed under chapter
157 and registered under section 157.17 to provide supportive services or health supervision
services; adult foster homes as defined in Minnesota Rules, part 9555.5105; day training
and habilitation services for adults with developmental disabilities as defined in section
252.41, subdivision 3; boarding care homes as defined in Minnesota Rules, part 4655.0100;
adult day care services as defined in section 245A.02, subdivision 2a; and home health
agencies as defined in Minnesota Rules, part 9505.0175, subpart 15, or licensed under
chapter 144A.

Sec. 114.

Minnesota Statutes 2020, section 325F.721, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

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

(b) "Covered setting" means an unlicensed setting providing sleeping accommodations
to one or more adult residents, at least 80 percent of which are 55 years of age or older, and
offering or providing, for a fee, supportive services. For the purposes of this section, covered
setting does not mean:

(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;

(2) a nursing home licensed under chapter 144A;

(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;

(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;

(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;

(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;

(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;

(8) temporary family health care dwellings as defined in sections 394.307 and 462.3593;

(9) settings offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;

(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;

(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;

(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;

(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011; or

(14) an assisted living facility licensed under chapter 144G.

(c) "'I'm okay' check services" means providing a service to, by any means, check on
the safety of a resident.

(d) "Resident" means a person entering into written contract for housing and services
with a covered setting.

(e) "Supportive services" means:

(1) assistance with laundry, shopping, and household chores;

(2) housekeeping services;

(3) provision of meals or assistance with meals or food preparation;

(4) help with arranging, or arranging transportation to, medical, social, recreational,
personal, or social services appointments; or

(5) provision of social or recreational services.

Arranging for services does not include making referrals or contacting a service provider
in an emergency.

Sec. 115. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2020, sections 245.462, subdivision 4a; 245.4879, subdivision
2; 245.62, subdivisions 3 and 4; 245.69, subdivision 2; 256B.0615, subdivision 2; 256B.0616,
subdivision 2; 256B.0622, subdivisions 3 and 5a; 256B.0623, subdivisions 7, 8, 10, and 11;
256B.0625, subdivisions 5l, 35a, 35b, 61, 62, and 65; 256B.0943, subdivisions 8 and 10;
256B.0944; and 256B.0946, subdivision 5, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Rules, parts 9505.0370; 9505.0371; 9505.0372; 9520.0010; 9520.0020;
9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090;
9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160;
9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210; 9520.0230; 9520.0750;
9520.0760; 9520.0770; 9520.0780; 9520.0790; 9520.0800; 9520.0810; 9520.0820;
9520.0830; 9520.0840; 9520.0850; 9520.0860; and 9520.0870, new text end new text begin are repealed.
 new text end

ARTICLE 10

FORECAST ADJUSTMENTS

Section 1. new text begin DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.
new text end

new text begin The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2019, First Special
Session chapter 9, article 14, from the general fund, or any other fund named, to the
commissioner of human services for the purposes specified in this article, to be available
for the fiscal year indicated for each purpose. The figure "2021" used in this article means
that the appropriations listed are available for the fiscal year ending June 30, 2021.
 new text end

new text begin APPROPRIATIONS
 new text end
new text begin Available for the Year
 new text end
new text begin Ending June 30
 new text end
new text begin 2021
 new text end

Sec. 2. new text begin COMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin (755,322,000)
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2021
 new text end
new text begin General
 new text end 		new text begin (692,529,000)
 new text end
new text begin Health Care Access
 new text end 		new text begin (38,888,000)
 new text end
new text begin Federal TANF
 new text end 		new text begin (23,905,000)
 new text end

new text begin Subd. 2. new text end

new text begin Forecasted Programs
 new text end

new text begin (a) Minnesota Family
Investment Program
(MFIP)/Diversionary Work
Program (DWP)
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2021
 new text end
new text begin General
 new text end 		new text begin 42,700,000
 new text end
new text begin Federal TANF
 new text end 		new text begin (23,911,000)
 new text end
new text begin (b) MFIP Child Care Assistance
 new text end 		new text begin (19,230,000)
 new text end
new text begin (c) General Assistance
 new text end 		new text begin 2,560,000
 new text end
new text begin (d) Minnesota Supplemental Aid
 new text end 		new text begin 3,672,000
 new text end
new text begin (e) Housing Support
 new text end 		new text begin 3,676,000
 new text end
new text begin (f) Northstar Care for Children
 new text end 		new text begin (8,435,000)
 new text end
new text begin (g) MinnesotaCare
 new text end 		new text begin (38,888,000)
 new text end

new text begin This appropriation is from the health care
access fund.
 new text end

new text begin (h) Medical Assistance
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2021
 new text end
new text begin General
 new text end 		new text begin (667,401,000)
 new text end
new text begin Health Care Access
 new text end 		new text begin -0-
 new text end
new text begin (i) Alternative Care
 new text end 		new text begin 247,000
 new text end
new text begin (j) Consolidated Chemical Dependency
Treatment Fund (CCDTF) Entitlement
 new text end 		new text begin (50,318,000)
 new text end

new text begin Subd. 3. new text end

new text begin Technical Activities
 new text end

new text begin 6,000
 new text end

new text begin This appropriation is from the federal TANF
fund.
 new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective the day following final enactment.
 new text end

ARTICLE 11

APPROPRIATIONS

Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
new text end

new text begin The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2022" and "2023" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2022, or June 30, 2023, respectively.
"The first year" is fiscal year 2022. "The second year" is fiscal year 2023. "The biennium"
is fiscal years 2022 and 2023.
 new text end

new text begin APPROPRIATIONS
 new text end
new text begin Available for the Year
 new text end
new text begin Ending June 30
 new text end
new text begin 2022
 new text end 		new text begin 2023
 new text end

Sec. 2. new text begin COMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 9,319,214,000
 new text end 		new text begin $
 new text end 		new text begin 9,441,484,000
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2022
 new text end 		new text begin 2023
 new text end
new text begin General
 new text end 		new text begin 8,160,825,000
 new text end 		new text begin 8,307,874,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 4,299,000
 new text end 		new text begin 4,299,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 858,608,000
 new text end 		new text begin 837,211,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 291,026,000
 new text end 		new text begin 287,644,000
 new text end
new text begin Lottery Prize
 new text end 		new text begin 1,896,000
 new text end 		new text begin 1,896,000
 new text end
new text begin Opiate Epidemic
Response
 new text end 		new text begin 2,560,000
 new text end 		new text begin 2,560,000
 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
 new text end

new text begin Subd. 2. new text end

new text begin TANF Maintenance of Effort
 new text end

new text begin (a) Nonfederal Expenditures. The
commissioner shall ensure that sufficient
qualified nonfederal expenditures are made
each year to meet the state's maintenance of
effort (MOE) requirements of the TANF block
grant specified under Code of Federal
Regulations, title 45, section 263.1. In order
to meet these basic TANF/MOE requirements,
the commissioner may report as TANF/MOE
expenditures only nonfederal money expended
for allowable activities listed in the following
clauses:
 new text end

new text begin (1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
 new text end

new text begin (2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
 new text end

new text begin (3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
 new text end

new text begin (4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;
 new text end

new text begin (5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
 new text end

new text begin (6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;
 new text end

new text begin (7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
 new text end

new text begin (8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
 new text end

new text begin (b) Nonfederal Expenditures; Reporting.
For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
 new text end

new text begin (c) Certain Expenditures Required. The
commissioner shall ensure that the MOE used
by the commissioner of management and
budget for the February and November
forecasts required under Minnesota Statutes,
section 16A.103, contains expenditures under
paragraph (a), clause (1), equal to zero percent
in fiscal year 2022, zero percent in fiscal year
2023, and beginning in fiscal year 2024, at
least 16 percent of the total required under
Code of Federal Regulations, title 45, section
263.1.
 new text end

new text begin (d) Limitation; Exceptions. The
commissioner must not claim an amount of
TANF/MOE in excess of the 75 percent
standard in Code of Federal Regulations, title
45, section 263.1(a)(2), except:
 new text end

new text begin (1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
 new text end

new text begin (2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
 new text end

new text begin (3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section 261.43
(a)(2).
 new text end

new text begin (e) Supplemental Expenditures. For the
purposes of paragraph (d), the commissioner
may supplement the MOE claim with working
family credit expenditures or other qualified
expenditures to the extent such expenditures
are otherwise available after considering the
expenditures allowed in this subdivision.
 new text end

new text begin (f) Reduction of Appropriations; Exception.
The requirement in Minnesota Statutes, section
256.011, subdivision 3, that federal grants or
aids secured or obtained under that subdivision
be used to reduce any direct appropriations
provided by law, does not apply if the grants
or aids are federal TANF funds.
 new text end

new text begin (g) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
 new text end

new text begin (h) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.
 new text end

new text begin (i) Federal SNAP Education and Training
Grants. Federal funds available during fiscal
years 2022 and 2023 for Supplemental
Nutrition Assistance Program Education and
Training and SNAP Quality Control
Performance Bonus grants are appropriated
to the commissioner of human services for the
purposes allowable under the terms of the
federal award. This paragraph is effective the
day following final enactment.
 new text end

new text begin Subd. 3. new text end

new text begin Central Office; Operations
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 159,449,000
 new text end 		new text begin 162,220,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 4,174,000
 new text end 		new text begin 4,174,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 16,966,000
 new text end 		new text begin 16,966,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 100,000
 new text end 		new text begin 100,000
 new text end

new text begin (a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
 new text end

new text begin (1) Minnesota Statutes, section 125A.744,
subdivision 3;
 new text end

new text begin (2) Minnesota Statutes, section 245.495,
paragraph (b);
 new text end

new text begin (3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
 new text end

new text begin (4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
 new text end

new text begin (5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and
 new text end

new text begin (6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
 new text end

new text begin (b) Base Level Adjustment. The general fund
base is $161,781,000 in fiscal year 2024 and
$161,934,000 in fiscal year 2025.
 new text end

new text begin Subd. 4. new text end

new text begin Central Office; Children and Families
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 17,623,000
 new text end 		new text begin 17,994,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 2,582,000
 new text end 		new text begin 2,582,000
 new text end

new text begin (a) Financial Institution Data Match and
Payment of Fees. The commissioner is
authorized to allocate up to $310,000 each
year in fiscal year 2022 and fiscal year 2023
from the systems special revenue account to
make payments to financial institutions in
exchange for performing data matches
between account information held by financial
institutions and the public authority's database
of child support obligors as authorized by
Minnesota Statutes, section 13B.06,
subdivision 7.
 new text end

new text begin (b) Base Level Adjustment. The general fund
base is $18,054,000 in fiscal year 2024 and
$18,054,000 in fiscal year 2025.
 new text end

new text begin Subd. 5. new text end

new text begin Central Office; Health Care
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 22,385,000
 new text end 		new text begin 22,593,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 28,168,000
 new text end 		new text begin 28,168,000
 new text end

new text begin (a) new text begin Case Management Benefit Study for
American Indians.new text end $200,000 in fiscal year
2022 is for a contract to conduct fiscal analysis
and development of standards for a targeted
case management benefit for American
Indians. The commissioner of human services
must consult the Minnesota Indian Affairs
Council in the development of any request for
proposal and in the evaluation of responses.
This is a onetime appropriation. Any
unencumbered balance remaining from the
first year does not cancel and is available for
the second year of the biennium.
 new text end

new text begin (b) new text begin Base Level Adjustment.new text end The general fund
base is $23,453,000 in fiscal year 2024 and
$23,512,000 in fiscal year 2025.
 new text end

new text begin Subd. 6. new text end

new text begin Central Office; Continuing Care for
Older Adults
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 17,451,000
 new text end 		new text begin 17,496,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 125,000
 new text end 		new text begin 125,000
 new text end

new text begin (a) Assisted Living Survey. $2,593,000 in
fiscal year 2022 and $2,593,000 in fiscal year
2023 are for development and administration
of a resident experience survey and family
survey for all housing with services
establishments and assisted living facilities.
These appropriations are available in either
year of the biennium. This paragraph does not
expire.
 new text end

new text begin (b) new text begin Evaluation on Equitable Access to Home
and Community-Based Waivers.new text end $190,000
in fiscal year 2022 and $235,000 in fiscal year
2023 are for an evaluation to identify and
address barriers to equitable access to home
and community-based services for people with
disabilities and older adults. The commissioner
shall partner with Black people, Indigenous
people, and people of color and lead agencies
to better understand institutional biases in the
home and community-based service system
and make recommendations to eliminate them.
This is a onetime appropriation.
 new text end

new text begin (c) new text begin Base Level Adjustment.new text end The general fund
base is $17,311,000 in fiscal year 2024 and
$17,381,000 in fiscal year 2025.
 new text end

new text begin Subd. 7. new text end

new text begin Central Office; Community Supports
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 33,934,000
 new text end 		new text begin 33,619,000
 new text end
new text begin Lottery Prize
 new text end 		new text begin 163,000
 new text end 		new text begin 163,000
 new text end
new text begin Opioid Epidemic
Response
 new text end 		new text begin 60,000
 new text end 		new text begin 60,000
 new text end

new text begin (a) Study of Self Directed Tiered Wage
Structure. $25,000 in fiscal year 2022 is for
a study of the feasibility of a tiered wage
structure for individual providers. This
appropriation is onetime. This appropriation
is available only if the labor agreement
between the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
 new text end

new text begin (b) Case Management Rate Methodology
Analysis. $300,000 in fiscal year 2022 and
$200,000 in fiscal year 2023 is for the fiscal
analysis needed to establish federally
compliant payment methodologies for all
Medical Assistance funded case management
services. This is a onetime appropriation.
 new text end

new text begin (c) Case Management Quality Improvement
and Training. $200,000 in fiscal year 2022
is for the development of reporting measures
to determine outcomes for case management
services and for the identification of training
needs and development of training tools across
all case management services. This is a
onetime appropriation. Any unencumbered
balance remaining from the first year does not
cancel and is available for the second year of
the biennium.
 new text end

new text begin (d) Homeless Management Information
System. $500,000 in fiscal year 2022 and
$500,000 in fiscal year 2023 are for support
of the Homeless Management Information
System (HMIS).
 new text end

new text begin (e) new text begin Base Level Adjustment.new text end The general fund
base is $33,667,000 in fiscal year 2024 and
$33,704,000 in fiscal year 2025. The opiate
epidemic response fund base is $60,000 in
fiscal year 2024 and $0 in fiscal year 2025.
 new text end

new text begin Subd. 8. new text end

new text begin Forecasted Programs; MFIP/DWP
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 75,674,000
 new text end 		new text begin 75,262,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 112,689,000
 new text end 		new text begin 110,251,000
 new text end

new text begin Subd. 9. new text end

new text begin Forecasted Programs; MFIP Child Care
Assistance
 new text end

new text begin 103,559,000
 new text end 		new text begin 110,880,000
 new text end

new text begin Subd. 10. new text end

new text begin Forecasted Programs; General
Assistance
 new text end

new text begin 52,841,000
 new text end 		new text begin 52,948,000
 new text end

new text begin (a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.
 new text end

new text begin (b) Emergency General Assistance Limit.
The amount appropriated for emergency
general assistance is limited to no more than
$6,729,812 in fiscal year 2022 and $6,729,812
in fiscal year 2023. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.
 new text end

new text begin Subd. 11. new text end

new text begin Forecasted Programs; Minnesota
Supplemental Aid
 new text end

new text begin 51,560,000
 new text end 		new text begin 52,486,000
 new text end

new text begin Subd. 12. new text end

new text begin Forecasted Programs; Housing
Support
 new text end

new text begin 182,448,000
 new text end 		new text begin 189,494,000
 new text end

new text begin Subd. 13. new text end

new text begin Forecasted Programs; Northstar Care
for Children
 new text end

new text begin 116,578,000
 new text end 		new text begin 121,196,000
 new text end

new text begin Subd. 14. new text end

new text begin Forecasted Programs; MinnesotaCare
 new text end

new text begin 198,831,000
 new text end 		new text begin 176,513,000
 new text end

new text begin Generally. This appropriation is from the
health care access fund.
 new text end

new text begin Subd. 15. new text end

new text begin Forecasted Programs; Medical
Assistance
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 6,347,136,000
 new text end 		new text begin 6,450,726,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 611,178,000
 new text end 		new text begin 612,099,000
 new text end

new text begin Behavioral Health Services. $1,000,000 in
fiscal year 2022 and $1,000,000 in fiscal year
2023 are for behavioral health services
provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).
 new text end

new text begin Subd. 16. new text end

new text begin Forecasted Programs; Alternative
Care
 new text end

new text begin 45,683,000
 new text end 		new text begin 45,662,000
 new text end

new text begin new text begin Alternative Care Transfer.new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
 new text end

new text begin Subd. 17. new text end

new text begin Forecasted Programs; Behavioral
Health Fund
 new text end

new text begin 102,629,000
 new text end 		new text begin 115,956,000
 new text end

new text begin Subd. 18. new text end

new text begin Grant Programs; Support Services
Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 8,715,000
 new text end 		new text begin 8,715,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 96,311,000
 new text end 		new text begin 96,311,000
 new text end

new text begin Subd. 19. new text end

new text begin Grant Programs; Basic Sliding Fee
Child Care Assistance Grants
 new text end

new text begin 53,599,000
 new text end 		new text begin 53,593,000
 new text end

new text begin Subd. 20. new text end

new text begin Grant Programs; Child Care
Development Grants
 new text end

new text begin 1,737,000
 new text end 		new text begin 1,737,000
 new text end

new text begin Subd. 21. new text end

new text begin Grant Programs; Child Support
Enforcement Grants
 new text end

new text begin 50,000
 new text end 		new text begin 50,000
 new text end

new text begin Subd. 22. new text end

new text begin Grant Programs; Children's Services
Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 51,983,000
 new text end 		new text begin 51,698,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 140,000
 new text end 		new text begin 140,000
 new text end

new text begin new text begin Title IV-E Adoption Assistance.new text end (1) The
commissioner shall allocate funds from the
Title IV-E reimbursement to the state from
the Fostering Connections to Success and
Increasing Adoptions Act for adoptive, foster,
and kinship families as required in Minnesota
Statutes, section 256N.261.
 new text end

new text begin (2) Additional federal reimbursement to the
state as a result of the Fostering Connections
to Success and Increasing Adoptions Act's
expanded eligibility for title IV-E adoption
assistance is for postadoption, foster care,
adoption, and kinship services, including a
parent-to-parent support network.
 new text end

new text begin Subd. 23. new text end

new text begin Grant Programs; Children and
Community Service Grants
 new text end

new text begin 60,251,000
 new text end 		new text begin 60,856,000
 new text end

new text begin Subd. 24. new text end

new text begin Grant Programs; Children and
Economic Support Grants
 new text end

new text begin 27,040,000
 new text end 		new text begin 27,040,000
 new text end

new text begin Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2022 do not
cancel but are available for this purpose in
fiscal year 2023.
 new text end

new text begin Subd. 25. new text end

new text begin Grant Programs; Health Care Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 4,811,000
 new text end 		new text begin 4,811,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 3,465,000
 new text end 		new text begin 3,465,000
 new text end

new text begin Integrated Care for High-Risk Pregnant
Women Grant Program. $1,100,000 in fiscal
year 2022 and $1,100,000 in fiscal year 2023
are for the integrated care for high-risk
pregnant women grant program under
Minnesota Statutes, section 256B.79.
 new text end

new text begin Subd. 26. new text end

new text begin Grant Programs; Other Long-Term
Care Grants
 new text end

new text begin 1,925,000
 new text end 		new text begin 1,925,000
 new text end

new text begin Subd. 27. new text end

new text begin Grant Programs; Aging and Adult
Services Grants
 new text end

new text begin 32,495,000
 new text end 		new text begin 32,495,000
 new text end

new text begin Subd. 28. new text end

new text begin Grant Programs; Deaf and
Hard-of-Hearing Grants
 new text end

new text begin 2,886,000
 new text end 		new text begin 2,886,000
 new text end

new text begin Subd. 29. new text end

new text begin Grant Programs; Disabilities Grants
 new text end

new text begin 18,651,000
 new text end 		new text begin 17,263,000
 new text end

new text begin Training Stipends for Direct Support
Services Providers. $1,000,000 in fiscal year
2022 is for stipends for individual providers
of direct support services as defined in
Minnesota Statutes, section 256B.0711,
subdivision 1. These stipends are available to
individual providers who have completed
designated voluntary trainings made available
through the State-Provider Cooperation
Committee formed by the State of Minnesota
and the Service Employees International
Union Healthcare Minnesota. Any unspent
appropriation in fiscal year 2022 is available
in fiscal year 2023. This is a onetime
appropriation. This appropriation is available
only if the labor agreement between the state
of Minnesota and the Service Employees
International Union Healthcare Minnesota
under Minnesota Statutes, section 179A.54,
is approved under Minnesota Statutes, section
3.855.
 new text end

new text begin Subd. 30. new text end

new text begin Grant Programs; Housing Support
Grants
 new text end

new text begin 15,364,000
 new text end 		new text begin 15,364,000
 new text end

new text begin Subd. 31. new text end

new text begin Grant Programs; Adult Mental Health
Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 81,043,000
 new text end 		new text begin 81,044,000
 new text end
new text begin Opiate Epidemic
Response
 new text end 		new text begin 2,000,000
 new text end 		new text begin 2,000,000
 new text end

new text begin Base Level Adjustment. The general fund
base is $82,324,000 in fiscal year 2024 and
$82,324,000 in fiscal year 2025.
 new text end

new text begin The Opiate Epidemic Response base is
$2,000,000 in fiscal year 2024 and $0 in fiscal
year 2025.
 new text end

new text begin Subd. 32. new text end

new text begin Grant Programs; Child Mental Health
Grants
 new text end

new text begin 25,703,000
 new text end 		new text begin 25,703,000
 new text end

new text begin new text begin Base Level Adjustment.new text end The general fund
base is $25,726,000 in fiscal year 2024 and
$25,726,000 in fiscal year 2025.
 new text end

new text begin Subd. 33. new text end

new text begin Grant Programs; Chemical
Dependency Treatment Support Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 2,273,000
 new text end 		new text begin 2,274,000
 new text end
new text begin Lottery Prize
 new text end 		new text begin 1,733,000
 new text end 		new text begin 1,733,000
 new text end
new text begin Opiate Epidemic
Response
 new text end 		new text begin 500,000
 new text end 		new text begin 500,000
 new text end

new text begin Problem Gambling. (a) $225,000 in fiscal
year 2022 and $225,000 in fiscal year 2023
are from the lottery prize fund for a grant to
the state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
and training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
 new text end

new text begin (b) The general fund base is $2,636,000 in
fiscal year 2024 and $2,636,000 in fiscal year
2025. The opiate epidemic response fund base
is $500,000 in fiscal year 2024 and $0 in fiscal
year 2025.
 new text end

new text begin Subd. 34. new text end

new text begin Direct Care and Treatment -
Generally
 new text end

new text begin new text begin Transfer Authority.new text end Money appropriated to
budget activities under this subdivision and
subdivisions 35, 36, 37, and 38, may be
transferred between budget activities and
between years of the biennium with the
approval of the commissioner of management
and budget.
 new text end

new text begin Subd. 35. new text end

new text begin Direct Care and Treatment - Mental
Health and Substance Abuse
 new text end

new text begin 142,940,000
 new text end 		new text begin 144,103,000
 new text end

new text begin (a) Transfer Authority. Money appropriated
to support the continued operations of the
Community Addiction Recovery Enterprise
(C.A.R.E.) program may be transferred to the
enterprise fund for C.A.R.E.
 new text end

new text begin (b) Operating Adjustment. $2,307,000 in
fiscal year 2022 and $2,453,000 in fiscal year
2023 are appropriated for the Community
Addiction Recovery Enterprise program. The
commissioner may transfer $2,307,000 in
fiscal year 2022 and $2,453,000 in fiscal year
2023 to the enterprise fund for Community
Addiction Recovery Enterprise.
 new text end

new text begin Subd. 36. new text end

new text begin Direct Care and Treatment -
Community-Based Services
 new text end

new text begin 18,695,000
 new text end 		new text begin 19,752,000
 new text end

new text begin (a) Transfer Authority. Money appropriated
to support the continued operations of the
Minnesota State Operated Community
Services (MSOCS) program may be
transferred to the enterprise fund for MSOCS.
 new text end

new text begin (b) Operating Adjustment. $1,519,000 in
fiscal year 2022 and $2,541,000 in fiscal year
2023 are appropriated for the Minnesota State
Operated Community Services program. The
commissioner may transfer $1,519,000 in
fiscal year 2022 and $2,541,000 in fiscal year
2023 to the enterprise fund for Minnesota State
Operated Community Services.
 new text end

new text begin Subd. 37. new text end

new text begin Direct Care and Treatment - Forensic
Services
 new text end

new text begin 121,039,000
 new text end 		new text begin 122,206,000
 new text end

new text begin Subd. 38. new text end

new text begin Direct Care and Treatment - Sex
Offender Program
 new text end

new text begin 98,833,000
 new text end 		new text begin 99,917,000
 new text end

new text begin new text begin Transfer Authority.new text end Money appropriated for
the Minnesota sex offender program may be
transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.
 new text end

new text begin Subd. 39. new text end

new text begin Direct Care and Treatment -
Operations
 new text end

new text begin 61,842,000
 new text end 		new text begin 65,910,000
 new text end

new text begin Subd. 40. new text end

new text begin Technical Activities
 new text end

new text begin 79,204,000
 new text end 		new text begin 78,260,000
 new text end

new text begin (a) Generally. This appropriation is from the
federal TANF fund.
 new text end

new text begin (b) Base Level Adjustment. The TANF fund
base is $71,493,000 in fiscal year 2024 and
$71,493,000 in fiscal year 2025.
 new text end

Sec. 3.

Laws 2017, chapter 13, article 1, section 15, as amended by Laws 2017, First
Special Session chapter 6, article 5, section 10, and Laws 2019, First Special Session chapter
9, article 8, section 19, is amended to read:


Sec. 15. MINNESOTA PREMIUM SECURITY PLAN FUNDING.

(a) The Minnesota Comprehensive Health Association shall fund the operational and
administrative costs and reinsurance payments of the Minnesota security plan and association
using the following amounts deposited in the premium security plan account in Minnesota
Statutes, section 62E.25, subdivision 1, in the following order:

(1) any federal funding available;

(2) funds deposited under article 1, sections 12 and 13;

(3) any state funds from the health care access fund; and

(4) any state funds from the general fund.

(b) The association shall transfer from the premium security plan account any remaining
state funds not used for the Minnesota premium security plan by June 30, 2023, to the
commissioner of commerce. Any amount transferred to the commissioner of commerce
shall be deposited in the deleted text begin health care access fund in Minnesota Statutes, section 16A.724deleted text end new text begin
general fund for the fiscal year starting on July 1, 2023new text end .

(c) The Minnesota Comprehensive Health Association may not spend more than
$271,000,000 for benefit year 2018 and not more than $271,000,000 for benefit year 2019
for the operational and administrative costs of, and reinsurance payments under, the
Minnesota premium security plan.

Sec. 4. new text begin APPROPRIATION; MINNESOTA FAMILY INVESTMENT PROGRAM
SUPPLEMENTAL PAYMENT.
new text end

new text begin $24,235,000 in fiscal year 2021 is appropriated from the TANF fund to the commissioner
of human services to provide a onetime cash benefit of up to $750 for each household
enrolled in the Minnesota family investment program or diversionary work program under
Minnesota Statutes, chapter 256J, at the time that the cash benefit is distributed. The
commissioner shall distribute these funds through existing systems and in a manner that
minimizes the burden to families. This is a onetime appropriation.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5. new text begin GAMBLING FUNDS BALANCE TRANSFER.
new text end

new text begin The commissioner shall cancel $1,000,000 from the available balance in accounts
established under Minnesota Statutes, section 297E.02, subdivision 3, paragraph (c), to the
general fund by June 30, 2021.
 new text end

Sec. 6. new text begin TRANSFERS; HUMAN SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Grants. new text end

new text begin The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2023, within fiscal years among the MFIP, general
assistance, medical assistance, MinnesotaCare, MFIP child care assistance under Minnesota
Statutes, section 119B.05, Minnesota supplemental aid program, group residential housing
program, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance Division
and the house of representatives Health and Human Services Finance Committee quarterly
about transfers made under this subdivision.
 new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin Positions, salary money, and nonsalary administrative money
may be transferred within the Department of Human Services as the commissioners consider
necessary, with the advance approval of the commissioner of management and budget. The
commissioner shall inform the chairs and ranking minority members of the senate Health
and Human Services Finance Division and the house of representatives Health and Human
Services Finance Committee quarterly about transfers made under this subdivision.
 new text end

Sec. 7. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end

new text begin The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.
 new text end

Sec. 8. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2023, unless a
different expiration date is explicit.
 new text end

Sec. 9. new text begin EFFECTIVE DATE.
new text end

new text begin This article is effective July 1, 2021, unless a different effective date is specified.
 new text end

APPENDIX

Repealed Minnesota Statutes: 21-02810

245.462 DEFINITIONS.

Subd. 4a.

Clinical supervision.

"Clinical supervision" means the oversight responsibility for individual treatment plans and individual mental health service delivery, including that provided by the case manager. Clinical supervision must be accomplished by full or part-time employment of or contracts with mental health professionals. Clinical supervision must be documented by the mental health professional cosigning individual treatment plans and by entries in the client's record regarding supervisory activities.

245.4879 EMERGENCY SERVICES.

Subd. 2.

Specific requirements.

(a) The county board shall require that all service providers of emergency services to the child with an emotional disturbance provide immediate direct access to a mental health professional during regular business hours. For evenings, weekends, and holidays, the service may be by direct toll-free telephone access to a mental health professional, a mental health practitioner, or until January 1, 1991, a designated person with training in human services who receives clinical supervision from a mental health professional.

(b) The commissioner may waive the requirement in paragraph (a) that the evening, weekend, and holiday service be provided by a mental health professional or mental health practitioner after January 1, 1991, if the county documents that:

(1) mental health professionals or mental health practitioners are unavailable to provide this service;

(2) services are provided by a designated person with training in human services who receives clinical supervision from a mental health professional; and

(3) the service provider is not also the provider of fire and public safety emergency services.

(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the evening, weekend, and holiday service not be provided by the provider of fire and public safety emergency services if:

(1) every person who will be providing the first telephone contact has received at least eight hours of training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;

(2) every person who will be providing the first telephone contact will annually receive at least four hours of continued training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;

(3) the local social service agency has provided public education about available emergency mental health services and can assure potential users of emergency services that their calls will be handled appropriately;

(4) the local social service agency agrees to provide the commissioner with accurate data on the number of emergency mental health service calls received;

(5) the local social service agency agrees to monitor the frequency and quality of emergency services; and

(6) the local social service agency describes how it will comply with paragraph (d).

(d) When emergency service during nonbusiness hours is provided by anyone other than a mental health professional, a mental health professional must be available on call for an emergency assessment and crisis intervention services, and must be available for at least telephone consultation within 30 minutes.

245.62 COMMUNITY MENTAL HEALTH CENTER.

Subd. 3.

Clinical supervisor.

All community mental health center services shall be provided under the clinical supervision of a licensed psychologist licensed under sections 148.88 to 148.98, or a physician who is board certified or eligible for board certification in psychiatry, and who is licensed under section 147.02.

Subd. 4.

Rules.

The commissioner shall promulgate rules to establish standards for the designation of an agency as a community mental health center. These standards shall include, but are not limited to:

(1) provision of mental health services in the prevention, identification, treatment and aftercare of emotional disorders, chronic and acute mental illness, developmental disabilities, and alcohol and drug abuse and dependency, including the services listed in section 245.61 except detoxification services;

(2) establishment of a community mental health center board pursuant to section 245.66; and

(3) approval pursuant to section 245.69, subdivision 2.

245.69 ADDITIONAL DUTIES OF COMMISSIONER.

Subd. 2.

Approval of centers and clinics.

The commissioner of human services has the authority to approve or disapprove public and private mental health centers and public and private mental health clinics for the purposes of section 62A.152, subdivision 2. For the purposes of this subdivision the commissioner shall promulgate rules in accordance with sections 14.001 to 14.69. The rules shall require each applicant to pay a fee to cover costs of processing applications and determining compliance with the rules and this subdivision. The commissioner may contract with any state agency, individual, corporation or association to which the commissioner shall delegate all but final approval and disapproval authority to determine compliance or noncompliance.

(a) Each approved mental health center and each approved mental health clinic shall have a multidisciplinary team of professional staff persons as required by rule. A mental health center or mental health clinic may provide the staffing required by rule by means of written contracts with professional persons or with other health care providers. Any personnel qualifications developed by rule shall be consistent with any personnel standards developed pursuant to chapter 214.

(b) Each approved mental health clinic and each approved mental health center shall establish a written treatment plan for each outpatient for whom services are reimbursable through insurance or public assistance. The treatment plan shall be developed in accordance with the rules and shall include a patient history, treatment goals, a statement of diagnosis and a treatment strategy. The clinic or center shall provide access to hospital admission as a bed patient as needed by any outpatient. The clinic or center shall ensure ongoing consultation among and availability of all members of the multidisciplinary team.

(c) As part of the required consultation, members of the multidisciplinary team shall meet at least twice monthly to conduct case reviews, peer consultations, treatment plan development and in-depth case discussion. Written minutes of these meetings shall be kept at the clinic or center for three years.

(d) Each approved center or clinic shall establish mechanisms for quality assurance and submit documentation concerning the mechanisms to the commissioner as required by rule, including:

(1) continuing education of each professional staff person;

(2) an ongoing internal utilization and peer review plan and procedures;

(3) mechanisms of staff supervision; and

(4) procedures for review by the commissioner or a delegate.

(e) The commissioner shall disapprove an applicant, or withdraw approval of a clinic or center, which the commissioner finds does not comply with the requirements of the rules or this subdivision. A clinic or center which is disapproved or whose approval is withdrawn is entitled to a contested case hearing and judicial review pursuant to sections 14.01 to 14.69.

(f) Data on individuals collected by approved clinics and centers, including written minutes of team meetings, is private data on individuals within the welfare system as provided in chapter 13.

(g) Each center or clinic that is approved and in compliance with the commissioner's existing rule on July 1, 1980, is approved for purposes of section 62A.152, subdivision 2, until rules are promulgated to implement this section.

245A.191 PROVIDER ELIGIBILITY FOR PAYMENTS FROM THE CHEMICAL DEPENDENCY CONSOLIDATED TREATMENT FUND.

(a) When a substance use disorder treatment provider licensed under this chapter, and governed by the standards of chapter 245G or Minnesota Rules, parts 2960.0430 to 2960.0490, agrees to meet the applicable requirements under section 254B.05, subdivision 5, to be eligible for enhanced funding from the chemical dependency consolidated treatment fund, the applicable requirements under section 254B.05 are also licensing requirements that may be monitored for compliance through licensing investigations and licensing inspections.

(b) Noncompliance with the requirements identified under paragraph (a) may result in:

(1) a correction order or a conditional license under section 245A.06, or sanctions under section 245A.07;

(2) nonpayment of claims submitted by the license holder for public program reimbursement;

(3) recovery of payments made for the service;

(4) disenrollment in the public payment program; or

(5) other administrative, civil, or criminal penalties as provided by law.

245C.10 BACKGROUND STUDY; FEES.

Subd. 2.

Supplemental nursing services agencies.

The commissioner shall recover the cost of the background studies initiated by supplemental nursing services agencies registered under section 144A.71, subdivision 1, through a fee of no more than $20 per study charged to the agency. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 2a.

Occupations regulated by commissioner of health.

The commissioner shall set fees to recover the cost of combined background studies and criminal background checks initiated by applicants, licensees, and certified practitioners regulated under sections 148.511 to 148.5198 and chapter 153A. The fees collected under this subdivision shall be deposited in the special revenue fund and are appropriated to the commissioner for the purpose of conducting background studies and criminal background checks.

Subd. 3.

Personal care provider organizations.

The commissioner shall recover the cost of background studies initiated by a personal care provider organization under sections 256B.0651 to 256B.0654 and 256B.0659 through a fee of no more than $20 per study charged to the organization responsible for submitting the background study form. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 4.

Temporary personnel agencies, educational programs, and professional services agencies.

The commissioner shall recover the cost of the background studies initiated by temporary personnel agencies, educational programs, and professional services agencies that initiate background studies under section 245C.03, subdivision 4, through a fee of no more than $20 per study charged to the agency. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 5.

Adult foster care and family adult day services.

The commissioner shall recover the cost of background studies required under section 245C.03, subdivision 1, for the purposes of adult foster care and family adult day services licensing, through a fee of no more than $20 per study charged to the license holder. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 6.

Unlicensed home and community-based waiver providers of service to seniors and individuals with disabilities.

The commissioner shall recover the cost of background studies initiated by unlicensed home and community-based waiver providers of service to seniors and individuals with disabilities under section 256B.4912 through a fee of no more than $20 per study.

Subd. 7.

Private agencies.

The commissioner shall recover the cost of conducting background studies under section 245C.33 for studies initiated by private agencies for the purpose of adoption through a fee of no more than $70 per study charged to the private agency. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 8.

Children's therapeutic services and supports providers.

The commissioner shall recover the cost of background studies required under section 245C.03, subdivision 7, for the purposes of children's therapeutic services and supports under section 256B.0943, through a fee of no more than $20 per study charged to the license holder. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 9.

Human services licensed programs.

The commissioner shall recover the cost of background studies required under section 245C.03, subdivision 1, for all programs that are licensed by the commissioner, except child foster care when the applicant or license holder resides in the home where child foster care services are provided, family child care, child care centers, certified license-exempt child care centers, and legal nonlicensed child care authorized under chapter 119B, through a fee of no more than $20 per study charged to the license holder. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 9a.

Child care programs.

The commissioner shall recover the cost of a background study required for family child care, certified license-exempt child care centers, licensed child care centers, and legal nonlicensed child care providers authorized under chapter 119B through a fee of no more than $40 per study charged to the license holder. A fee of no more than $20 per study shall be charged for studies conducted under section 245C.05, subdivision 5a, paragraph (a). The fees collected under this subdivision are appropriated to the commissioner to conduct background studies.

Subd. 10.

Community first services and supports organizations.

The commissioner shall recover the cost of background studies initiated by an agency-provider delivering services under section 256B.85, subdivision 11, or a financial management services provider providing service functions under section 256B.85, subdivision 13, through a fee of no more than $20 per study, charged to the organization responsible for submitting the background study form. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 11.

Providers of housing support.

The commissioner shall recover the cost of background studies initiated by providers of housing support under section 256I.04 through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 12.

Child protection workers or social services staff having responsibility for child protective duties.

The commissioner shall recover the cost of background studies initiated by county social services agencies and local welfare agencies for individuals who are required to have a background study under section 626.559, subdivision 1b, through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 13.

Providers of special transportation service.

The commissioner shall recover the cost of background studies initiated by providers of special transportation service under section 174.30 through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Subd. 14.

Children's residential facilities.

The commissioner shall recover the cost of background studies initiated by a licensed children's residential facility through a fee of no more than $51 per study. Fees collected under this subdivision are appropriated to the commissioner for purposes of conducting background studies.

Subd. 16.

Providers of housing support services.

The commissioner shall recover the cost of background studies initiated by providers of housing support services under section 256B.051 through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

256B.0596 MENTAL HEALTH CASE MANAGEMENT.

Counties shall contract with eligible providers willing to provide mental health case management services under section 256B.0625, subdivision 20. In order to be eligible, in addition to general provider requirements under this chapter, the provider must:

(1) be willing to provide the mental health case management services; and

(2) have a minimum of at least one contact with the client per week. This section is not intended to limit the ability of a county to provide its own mental health case management services.

256B.0615 MENTAL HEALTH CERTIFIED PEER SPECIALIST.

Subd. 2.

Establishment.

The commissioner of human services shall establish a certified peer specialist program model, which:

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

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

(3) is individualized to the consumer; and

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

256B.0616 MENTAL HEALTH CERTIFIED FAMILY PEER SPECIALIST.

Subd. 2.

Establishment.

The commissioner of human services shall establish a certified family peer specialists program model which:

(1) provides nonclinical family peer support counseling, building on the strengths of families and helping them achieve desired outcomes;

(2) collaborates with others providing care or support to the family;

(3) provides nonadversarial advocacy;

(4) promotes the individual family culture in the treatment milieu;

(5) links parents to other parents in the community;

(6) offers support and encouragement;

(7) assists parents in developing coping mechanisms and problem-solving skills;

(8) promotes resiliency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services;

(9) establishes and provides peer-led parent support groups; and

(10) increases the child's ability to function better within the child's home, school, and community by educating parents on community resources, assisting with problem solving, and educating parents on mental illnesses.

256B.0622 ASSERTIVE COMMUNITY TREATMENT AND INTENSIVE RESIDENTIAL TREATMENT SERVICES.

Subd. 3.

Eligibility for intensive residential treatment services.

An eligible client for intensive residential treatment services is an individual who:

(1) is age 18 or older;

(2) is eligible for medical assistance;

(3) is diagnosed with a mental illness;

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

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

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

Subd. 5a.

Standards for intensive residential rehabilitative mental health services.

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

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

(c) At a minimum:

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

(2) staff must remain awake during all work hours;

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

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

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

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

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

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

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

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

256B.0623 ADULT REHABILITATIVE MENTAL HEALTH SERVICES COVERED.

Subd. 7.

Personnel file.

The adult rehabilitative mental health services provider entity must maintain a personnel file on each staff. Each file must contain:

(1) an annual performance review;

(2) a summary of on-site service observations and charting review;

(3) a criminal background check of all direct service staff;

(4) evidence of academic degree and qualifications;

(5) a copy of professional license;

(6) any job performance recognition and disciplinary actions;

(7) any individual staff written input into own personnel file;

(8) all clinical supervision provided; and

(9) documentation of compliance with continuing education requirements.

Subd. 8.

Diagnostic assessment.

Providers of adult rehabilitative mental health services must complete a diagnostic assessment as defined in section 245.462, subdivision 9, within five days after the recipient's second visit or within 30 days after intake, whichever occurs first. In cases where a diagnostic assessment is available that reflects the recipient's current status, and has been completed within three years preceding admission, an adult diagnostic assessment update must be completed. An update shall include a face-to-face interview with the recipient and a written summary by a mental health professional of the recipient's current mental health status and service needs. If the recipient's mental health status has changed significantly since the adult's most recent diagnostic assessment, a new diagnostic assessment is required.

Subd. 10.

Individual treatment plan.

All providers of adult rehabilitative mental health services must develop and implement an individual treatment plan for each recipient. The provisions in clauses (1) and (2) apply:

(1) Individual treatment plan means a plan of intervention, treatment, and services for an individual recipient written by a mental health professional or by a mental health practitioner under the clinical supervision of a mental health professional. The individual treatment plan must be based on diagnostic and functional assessments. To the extent possible, the development and implementation of a treatment plan must be a collaborative process involving the recipient, and with the permission of the recipient, the recipient's family and others in the recipient's support system. Providers of adult rehabilitative mental health services must develop the individual treatment plan within 30 calendar days of intake. The treatment plan must be updated at least every six months thereafter, or more often when there is significant change in the recipient's situation or functioning, or in services or service methods to be used, or at the request of the recipient or the recipient's legal guardian.

(2) The individual treatment plan must include:

(i) a list of problems identified in the assessment;

(ii) the recipient's strengths and resources;

(iii) concrete, measurable goals to be achieved, including time frames for achievement;

(iv) specific objectives directed toward the achievement of each one of the goals;

(v) documentation of participants in the treatment planning. The recipient, if possible, must be a participant. The recipient or the recipient's legal guardian must sign the treatment plan, or documentation must be provided why this was not possible. A copy of the plan must be given to the recipient or legal guardian. Referral to formal services must be arranged, including specific providers where applicable;

(vi) cultural considerations, resources, and needs of the recipient must be included;

(vii) planned frequency and type of services must be initiated; and

(viii) clear progress notes on outcome of goals.

(3) The individual community support plan defined in section 245.462, subdivision 12, may serve as the individual treatment plan if there is involvement of a mental health case manager, and with the approval of the recipient. The individual community support plan must include the criteria in clause (2).

Subd. 11.

Recipient file.

Providers of adult rehabilitative mental health services must maintain a file for each recipient that contains the following information:

(1) diagnostic assessment or verification of its location that is current and that was reviewed by a mental health professional who is employed by or under contract with the provider entity;

(2) functional assessments;

(3) individual treatment plans signed by the recipient and the mental health professional, or if the recipient refused to sign the plan, the date and reason stated by the recipient as to why the recipient would not sign the plan;

(4) recipient history;

(5) signed release forms;

(6) recipient health information and current medications;

(7) emergency contacts for the recipient;

(8) case records which document the date of service, the place of service delivery, signature of the person providing the service, nature, extent and units of service, and place of service delivery;

(9) contacts, direct or by telephone, with recipient's family or others, other providers, or other resources for service coordination;

(10) summary of recipient case reviews by staff; and

(11) written information by the recipient that the recipient requests be included in the file.

256B.0625 COVERED SERVICES.

Subd. 5l.

Intensive mental health outpatient treatment.

Medical assistance covers intensive mental health outpatient treatment for dialectical behavioral therapy. The commissioner shall establish:

(1) certification procedures to ensure that providers of these services are qualified; and

(2) treatment protocols including required service components and criteria for admission, continued treatment, and discharge.

Subd. 18c.

Nonemergency Medical Transportation Advisory Committee.

(a) The Nonemergency Medical Transportation Advisory Committee shall advise the commissioner on the administration of nonemergency medical transportation covered under medical assistance. The advisory committee shall meet at least quarterly the first year following January 1, 2015, and at least biannually thereafter and may meet more frequently as required by the commissioner. The advisory committee shall annually elect a chair from among its members, who shall work with the commissioner or the commissioner's designee to establish the agenda for each meeting. The commissioner, or the commissioner's designee, shall attend all advisory committee meetings.

(b) The Nonemergency Medical Transportation Advisory Committee shall advise and make recommendations to the commissioner on:

(1) updates to the nonemergency medical transportation policy manual;

(2) other aspects of the nonemergency medical transportation system, as requested by the commissioner; and

(3) other aspects of the nonemergency medical transportation system, as requested by:

(i) a committee member, who may request an item to be placed on the agenda for a future meeting. The request may be considered by the committee and voted upon. If the motion carries, the meeting agenda item may be developed for presentation to the committee; and

(ii) a member of the public, who may approach the committee by letter or e-mail requesting that an item be placed on a future meeting agenda. The request may be considered by the committee and voted upon. If the motion carries, the agenda item may be developed for presentation to the committee.

(c) The Nonemergency Medical Transportation Advisory Committee shall coordinate its activities with the Minnesota Council on Transportation Access established under section 174.285. The chair of the advisory committee, or the chair's designee, shall attend all meetings of the Minnesota Council on Transportation Access.

(d) The Nonemergency Medical Transportation Advisory Committee shall expire December 1, 2019.

Subd. 18d.

Advisory committee members.

(a) The Nonemergency Medical Transportation Advisory Committee consists of:

(1) four voting members who represent counties, utilizing the rural urban commuting area classification system. As defined in subdivision 17, these members shall be designated as follows:

(i) two counties within the 11-county metropolitan area;

(ii) one county representing the rural area of the state; and

(iii) one county representing the super rural area of the state.

The Association of Minnesota Counties shall appoint one county within the 11-county metropolitan area and one county representing the super rural area of the state. The Minnesota Inter-County Association shall appoint one county within the 11-county metropolitan area and one county representing the rural area of the state;

(2) three voting members who represent medical assistance recipients, including persons with physical and developmental disabilities, persons with mental illness, seniors, children, and low-income individuals;

(3) five voting members who represent providers that deliver nonemergency medical transportation services to medical assistance enrollees, one of whom is a taxicab owner or operator;

(4) two voting members of the house of representatives, one from the majority party and one from the minority party, appointed by the speaker of the house, and two voting members from the senate, one from the majority party and one from the minority party, appointed by the Subcommittee on Committees of the Committee on Rules and Administration;

(5) one voting member who represents demonstration providers as defined in section 256B.69, subdivision 2;

(6) one voting member who represents an organization that contracts with state or local governments to coordinate transportation services for medical assistance enrollees;

(7) one voting member who represents the Minnesota State Council on Disability;

(8) the commissioner of transportation or the commissioner's designee, who shall serve as a voting member;

(9) one voting member appointed by the Minnesota Ambulance Association; and

(10) one voting member appointed by the Minnesota Hospital Association.

(b) Members of the advisory committee shall not be employed by the Department of Human Services. Members of the advisory committee shall receive no compensation.

Subd. 18e.

Single administrative structure and delivery system.

The commissioner, in coordination with the commissioner of transportation, shall implement a single administrative structure and delivery system for nonemergency medical transportation, beginning the latter of the date the single administrative assessment tool required in this subdivision is available for use, as determined by the commissioner or by July 1, 2016.

In coordination with the Department of Transportation, the commissioner shall develop and authorize a web-based single administrative structure and assessment tool, which must operate 24 hours a day, seven days a week, to facilitate the enrollee assessment process for nonemergency medical transportation services. The web-based tool shall facilitate the transportation eligibility determination process initiated by clients and client advocates; shall include an accessible automated intake and assessment process and real-time identification of level of service eligibility; and shall authorize an appropriate and auditable mode of transportation authorization. The tool shall provide a single framework for reconciling trip information with claiming and collecting complaints regarding inappropriate level of need determinations, inappropriate transportation modes utilized, and interference with accessing nonemergency medical transportation. The web-based single administrative structure shall operate on a trial basis for one year from implementation and, if approved by the commissioner, shall be permanent thereafter. The commissioner shall seek input from the Nonemergency Medical Transportation Advisory Committee to ensure the software is effective and user-friendly and make recommendations regarding funding of the single administrative system.

Subd. 18h.

Managed care.

(a) The following subdivisions apply to managed care plans and county-based purchasing plans:

(1) subdivision 17, paragraphs (a), (b), (i), and (n);

(2) subdivision 18; and

(3) subdivision 18a.

(b) A nonemergency medical transportation provider must comply with the operating standards for special transportation service specified in sections 174.29 to 174.30 and Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire vehicles are exempt from the requirements in this paragraph.

Subd. 35a.

Children's mental health crisis response services.

Medical assistance covers children's mental health crisis response services according to section 256B.0944.

Subd. 35b.

Children's therapeutic services and supports.

Medical assistance covers children's therapeutic services and supports according to section 256B.0943.

Subd. 61.

Family psychoeducation services.

Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers family psychoeducation services provided to a child up to age 21 with a diagnosed mental health condition when identified in the child's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who has determined it medically necessary to involve family members in the child's care. For the purposes of this subdivision, "family psychoeducation services" means information or demonstration provided to an individual or family as part of an individual, family, multifamily group, or peer group session to explain, educate, and support the child and family 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.

Subd. 62.

Mental health clinical care consultation.

Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers clinical care consultation for a person up to age 21 who is diagnosed with a complex mental health condition or a mental health condition that co-occurs with other complex and chronic conditions, when described in the person's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C. For the purposes of this subdivision, "clinical care consultation" means communication from a treating mental health professional to other providers or educators not under the clinical supervision of the treating mental health professional who are 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; and to direct and coordinate clinical service components provided to the client and family.

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).

256B.0916 EXPANSION OF HOME AND COMMUNITY-BASED SERVICES.

Subd. 2.

Distribution of funds; partnerships.

(a) Beginning with fiscal year 2000, the commissioner shall distribute all funding available for home and community-based waiver services for persons with developmental disabilities to individual counties or to groups of counties that form partnerships to jointly plan, administer, and authorize funding for eligible individuals. The commissioner shall encourage counties to form partnerships that have a sufficient number of recipients and funding to adequately manage the risk and maximize use of available resources.

(b) Counties must submit a request for funds and a plan for administering the program as required by the commissioner. The plan must identify the number of clients to be served, their ages, and their priority listing based on:

(1) requirements in Minnesota Rules, part 9525.1880; and

(2) statewide priorities identified in section 256B.092, subdivision 12.

The plan must also identify changes made to improve services to eligible persons and to improve program management.

(c) In allocating resources to counties, priority must be given to groups of counties that form partnerships to jointly plan, administer, and authorize funding for eligible individuals and to counties determined by the commissioner to have sufficient waiver capacity to maximize resource use.

(d) Within 30 days after receiving the county request for funds and plans, the commissioner shall provide a written response to the plan that includes the level of resources available to serve additional persons.

(e) Counties are eligible to receive medical assistance administrative reimbursement for administrative costs under criteria established by the commissioner.

(f) The commissioner shall manage waiver allocations in such a manner as to fully use available state and federal waiver appropriations.

Subd. 3.

Failure to develop partnerships or submit a plan.

(a) By October 1 of each year the commissioner shall notify the county board if any county determined by the commissioner to have insufficient capacity to maximize use of available resources fails to develop a partnership with other counties or fails to submit a plan as required in subdivision 2. The commissioner shall provide needed technical assistance to a county or group of counties that fails to form a partnership or submit a plan. If a county has not joined a county partnership or submitted a plan within 30 days following the notice by the commissioner of its failure, the commissioner shall require and assist that county to develop a plan or contract with another county or group of counties to plan and administer the waiver services program in that county.

(b) Counties may request technical assistance, management information, and administrative support from the commissioner at any time. The commissioner shall respond to county requests within 30 days. Priority shall be given to activities that support the administrative needs of newly formed county partnerships.

Subd. 4.

Allowed reserve.

Counties or groups of counties participating in partnerships that have submitted a plan under this section may develop an allowed reserve amount to meet crises and other unmet needs of current home and community-based waiver recipients. The amount of the allowed reserve shall be a county specific amount based upon documented past experience and projected need for the coming year described in an allowed reserve plan submitted for approval to the commissioner with the allocation request for the fiscal year.

Subd. 5.

Allocation of new diversions and priorities for reassignment of resources for developmental disabilities.

(a) The commissioner shall monitor county utilization of allocated resources and, as appropriate, reassign resources not utilized.

(b) Effective July 1, 2002, the commissioner shall authorize the spending of new diversion resources beginning January 1 of each year.

(c) Effective July 1, 2002, the commissioner shall manage the reassignment of waiver resources that occur from persons who have left the waiver in a manner that results in the cost reduction equivalent to delaying the reuse of those waiver resources by 180 days.

(d) Priority consideration for reassignment of resources shall be given to counties that form partnerships. In addition to the priorities listed in Minnesota Rules, part 9525.1880, the commissioner shall also give priority consideration to persons whose living situations are unstable due to the age or incapacity of the primary caregiver and to children to avoid out-of-home placement.

Subd. 8.

Financial and wait-list data reporting.

(a) The commissioner shall make available financial and waiting list information on the department's website.

(b) The financial information must include:

(1) the most recent end of session forecast available for the disability home and community-based waiver programs authorized under sections 256B.092 and 256B.49; and

(2) the most current financial information, updated at least monthly for the disability home and community-based waiver program authorized under section 256B.092 and three disability home and community-based waiver programs authorized under section 256B.49 for each county and tribal agency, including:

(i) the amount of resources allocated;

(ii) the amount of resources authorized for participants; and

(iii) the amount of allocated resources not authorized and the amount not used as provided in subdivision 12, and section 256B.49, subdivision 27.

(c) The waiting list information must be provided quarterly beginning August 1, 2016, and must include at least:

(1) the number of persons screened and waiting for services listed by urgency category, the number of months on the wait list, age group, and the type of services requested by those waiting;

(2) the number of persons beginning waiver services who were on the waiting list, and the number of persons beginning waiver services who were not on the waiting list;

(3) the number of persons who left the waiting list but did not begin waiver services; and

(4) the number of persons on the waiting list with approved funding but without a waiver service agreement and the number of days from funding approval until a service agreement is effective for each person.

(d) By December 1 of each year, the commissioner shall compile a report posted on the department's website that includes:

(1) the financial information listed in paragraph (b) for the most recently completed allocation period;

(2) for the previous four quarters, the waiting list information listed in paragraph (c);

(3) for a 12-month period ending October 31, a list of county and tribal agencies required to submit a corrective action plan under subdivisions 11 and 12, and section 256B.49, subdivisions 26 and 27; and

(4) for a 12-month period ending October 31, a list of the county and tribal agencies from which resources were moved as authorized in section 256B.092, subdivision 12, and section 256B.49, subdivision 11a, the amount of resources taken from each agency, the counties that were given increased resources as a result, and the amounts provided.

Subd. 11.

Excess spending.

County and tribal agencies are responsible for spending in excess of the allocation made by the commissioner. In the event a county or tribal agency spends in excess of the allocation made by the commissioner for a given allocation period, they must submit a corrective action plan to the commissioner for approval. The plan must state the actions the agency will take to correct their overspending for the two years following the period when the overspending occurred. The commissioner shall recoup spending in excess of the allocation only in cases where statewide spending exceeds the appropriation designated for the home and community-based services waivers. Nothing in this subdivision shall be construed as reducing the county's responsibility to offer and make available feasible home and community-based options to eligible waiver recipients within the resources allocated to them for that purpose.

Subd. 12.

Use of waiver allocations.

County and tribal agencies are responsible for spending the annual allocation made by the commissioner. In the event a county or tribal agency spends less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services. If a county or tribe does not submit a plan when required or implement the changes required, the commissioner shall assure access to waiver services within the county's or tribe's available allocation and take other actions needed to assure that all waiver participants in that county or tribe are receiving appropriate waiver services to meet their needs.

256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.

Subd. 8.

Required preservice and continuing education.

(a) A provider entity shall establish a plan to provide preservice and continuing education for staff. The plan must clearly describe the type of training necessary to maintain current skills and obtain new skills and that relates to the provider entity's goals and objectives for services offered.

(b) A provider that employs a mental health behavioral aide under this section must require the mental health behavioral aide to complete 30 hours of preservice training. The preservice training must include parent team training. The preservice training must include 15 hours of in-person training of a mental health behavioral aide in mental health services delivery and eight hours of parent team training. Curricula for parent team training must be approved in advance by the commissioner. Components of parent team training include:

(1) partnering with parents;

(2) fundamentals of family support;

(3) fundamentals of policy and decision making;

(4) defining equal partnership;

(5) complexities of the parent and service provider partnership in multiple service delivery systems due to system strengths and weaknesses;

(6) sibling impacts;

(7) support networks; and

(8) community resources.

(c) A provider entity that employs a mental health practitioner and a mental health behavioral aide to provide children's therapeutic services and supports under this section must require the mental health practitioner and mental health behavioral aide to complete 20 hours of continuing education every two calendar years. The continuing education must be related to serving the needs of a child with emotional disturbance in the child's home environment and the child's family.

(d) The provider entity must document the mental health practitioner's or mental health behavioral aide's annual completion of the required continuing education. The documentation must include the date, subject, and number of hours of the continuing education, and attendance records, as verified by the staff member's signature, job title, and the instructor's name. The provider entity must keep documentation for each employee, including records of attendance at professional workshops and conferences, at a central location and in the employee's personnel file.

Subd. 10.

Service authorization.

Children's therapeutic services and supports are subject to authorization criteria and standards published by the commissioner according to section 256B.0625, subdivision 25.

256B.0944 CHILDREN'S MENTAL HEALTH CRISIS RESPONSE SERVICES.

Subdivision 1.

Definitions.

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

(a) "Mental health crisis" means a child's behavioral, emotional, or psychiatric situation that, but for the provision of crisis response services to the child, would likely result in significantly reduced levels of functioning in primary activities of daily living, an emergency situation, or the child's placement in a more restrictive setting, including, but not limited to, inpatient hospitalization.

(b) "Mental health emergency" means a child's behavioral, emotional, or psychiatric situation that causes an immediate need for mental health services and is consistent with section 62Q.55. A physician, mental health professional, or crisis mental health practitioner determines a mental health crisis or emergency for medical assistance reimbursement with input from the client and the client's family, if possible.

(c) "Mental health crisis assessment" means an immediate face-to-face assessment by a physician, mental health professional, or mental health practitioner under the clinical supervision of a mental health professional, following a screening that suggests the child may be experiencing a mental health crisis or mental health emergency situation.

(d) "Mental health mobile crisis intervention services" means face-to-face, short-term intensive mental health services initiated during a mental health crisis or mental health emergency. Mental health mobile crisis services must help the recipient cope with immediate stressors, identify and utilize available resources and strengths, and begin to return to the recipient's baseline level of functioning. Mental health mobile services must be provided on site by a mobile crisis intervention team outside of an inpatient hospital setting.

(e) "Mental health crisis stabilization services" means individualized mental health services provided to a recipient following crisis intervention services that are designed to restore the recipient to the recipient's prior functional level. The individual treatment plan recommending mental health crisis stabilization must be completed by the intervention team or by staff after an inpatient or urgent care visit. Mental health crisis stabilization services may be provided in the recipient's home, the home of a family member or friend of the recipient, schools, another community setting, or a short-term supervised, licensed residential program if the service is not included in the facility's cost pool or per diem. Mental health crisis stabilization is not reimbursable when provided as part of a partial hospitalization or day treatment program.

Subd. 2.

Medical assistance coverage.

Medical assistance covers medically necessary children's mental health crisis response services, subject to federal approval, if provided to an eligible recipient under subdivision 3, by a qualified provider entity under subdivision 4 or a qualified individual provider working within the provider's scope of practice, and identified in the recipient's individual crisis treatment plan under subdivision 8.

Subd. 3.

Eligibility.

An eligible recipient is an individual who:

(1) is eligible for medical assistance;

(2) is under age 18 or between the ages of 18 and 21;

(3) is screened as possibly experiencing a mental health crisis or mental health emergency where a mental health crisis assessment is needed;

(4) is assessed as experiencing a mental health crisis or mental health emergency, and mental health mobile crisis intervention or mental health crisis stabilization services are determined to be medically necessary; and

(5) meets the criteria for emotional disturbance or mental illness.

Subd. 4.

Provider entity standards.

(a) A crisis intervention and crisis stabilization provider entity must meet the administrative and clinical standards specified in section 256B.0943, subdivisions 5 and 6, meet the standards listed in paragraph (b), and be:

(1) an Indian health service facility or facility owned and operated by a tribe or a tribal organization operating under Public Law 93-638 as a 638 facility;

(2) a county board-operated entity; or

(3) a provider entity that is under contract with the county board in the county where the potential crisis or emergency is occurring.

(b) The children's mental health crisis response services provider entity must:

(1) ensure that mental health crisis assessment and mobile crisis intervention services are available 24 hours a day, seven days a week;

(2) directly provide the services or, if services are subcontracted, the provider entity must maintain clinical responsibility for services and billing;

(3) ensure that crisis intervention services are provided in a manner consistent with sections 245.487 to 245.4889; and

(4) develop and maintain written policies and procedures regarding service provision that include safety of staff and recipients in high-risk situations.

Subd. 4a.

Alternative provider standards.

If a provider entity demonstrates that, due to geographic or other barriers, it is not feasible to provide mobile crisis intervention services 24 hours a day, seven days a week, according to the standards in subdivision 4, paragraph (b), clause (1), the commissioner may approve a crisis response provider based on an alternative plan proposed by a provider entity. The alternative plan must:

(1) result in increased access and a reduction in disparities in the availability of crisis services; and

(2) provide mobile services outside of the usual nine-to-five office hours and on weekends and holidays.

Subd. 5.

Mobile crisis intervention staff qualifications.

(a) To provide children's mental health mobile crisis intervention services, a mobile crisis intervention team must include:

(1) at least two mental health professionals as defined in section 256B.0943, subdivision 1, paragraph (o); or

(2) a combination of at least one mental health professional and one mental health practitioner as defined in section 245.4871, subdivision 26, with the required mental health crisis training and under the clinical supervision of a mental health professional on the team.

(b) The team must have at least two people with at least one member providing on-site crisis intervention services when needed. Team members must be experienced in mental health assessment, crisis intervention techniques, and clinical decision making under emergency conditions and have knowledge of local services and resources. The team must recommend and coordinate the team's services with appropriate local resources, including the county social services agency, mental health service providers, and local law enforcement, if necessary.

Subd. 6.

Initial screening and crisis assessment planning.

(a) Before initiating mobile crisis intervention services, a screening of the potential crisis situation must be conducted. The screening may use the resources of crisis assistance and emergency services as defined in sections 245.4871, subdivision 14, and 245.4879, subdivisions 1 and 2. The screening must gather information, determine whether a crisis situation exists, identify the parties involved, and determine an appropriate response.

(b) If a crisis exists, a crisis assessment must be completed. A crisis assessment must evaluate any immediate needs for which emergency services are needed and, as time permits, the recipient's current life situation, sources of stress, mental health problems and symptoms, strengths, cultural considerations, support network, vulnerabilities, and current functioning.

(c) If the crisis assessment determines mobile crisis intervention services are needed, the intervention services must be provided promptly. As the opportunity presents itself during the intervention, at least two members of the mobile crisis intervention team must confer directly or by telephone about the assessment, treatment plan, and actions taken and needed. At least one of the team members must be on site providing crisis intervention services. If providing on-site crisis intervention services, a mental health practitioner must seek clinical supervision as required under subdivision 9.

(d) The mobile crisis intervention team must develop an initial, brief crisis treatment plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention. The plan must address the needs and problems noted in the crisis assessment and include measurable short-term goals, cultural considerations, and frequency and type of services to be provided to achieve the goals and reduce or eliminate the crisis. The crisis treatment plan must be updated as needed to reflect current goals and services. The team must involve the client and the client's family in developing and implementing the plan.

(e) The team must document in progress notes which short-term goals have been met and when no further crisis intervention services are required.

(f) If the client's crisis is stabilized, but the client needs a referral for mental health crisis stabilization services or to other services, the team must provide a referral to these services. If the recipient has a case manager, planning for other services must be coordinated with the case manager.

Subd. 7.

Crisis stabilization services.

Crisis stabilization services must be provided by a mental health professional or a mental health practitioner, as defined in section 245.462, subdivision 17, who works under the clinical supervision of a mental health professional and for a crisis stabilization services provider entity and must meet the following standards:

(1) a crisis stabilization treatment plan must be developed which meets the criteria in subdivision 8;

(2) services must be delivered according to the treatment plan and include face-to-face contact with the recipient by qualified staff for further assessment, help with referrals, updating the crisis stabilization treatment plan, supportive counseling, skills training, and collaboration with other service providers in the community; and

(3) mental health practitioners must have completed at least 30 hours of training in crisis intervention and stabilization during the past two years.

Subd. 8.

Treatment plan.

(a) The individual crisis stabilization treatment plan must include, at a minimum:

(1) a list of problems identified in the assessment;

(2) a list of the recipient's strengths and resources;

(3) concrete, measurable short-term goals and tasks to be achieved, including time frames for achievement of the goals;

(4) specific objectives directed toward the achievement of each goal;

(5) documentation of the participants involved in the service planning;

(6) planned frequency and type of services initiated;

(7) a crisis response action plan if a crisis should occur; and

(8) clear progress notes on the outcome of goals.

(b) The client, if clinically appropriate, must be a participant in the development of the crisis stabilization treatment plan. The client or the client's legal guardian must sign the service plan or documentation must be provided why this was not possible. A copy of the plan must be given to the client and the client's legal guardian. The plan should include services arranged, including specific providers where applicable.

(c) A treatment plan must be developed by a mental health professional or mental health practitioner under the clinical supervision of a mental health professional. A written plan must be completed within 24 hours of beginning services with the client.

Subd. 9.

Supervision.

(a) A mental health practitioner may provide crisis assessment and mobile crisis intervention services if the following clinical supervision requirements are met:

(1) the mental health provider entity must accept full responsibility for the services provided;

(2) the mental health professional of the provider entity, who is an employee or under contract with the provider entity, must be immediately available by telephone or in person for clinical supervision;

(3) the mental health professional is consulted, in person or by telephone, during the first three hours when a mental health practitioner provides on-site service; and

(4) the mental health professional must review and approve the tentative crisis assessment and crisis treatment plan, document the consultation, and sign the crisis assessment and treatment plan within the next business day.

(b) If the mobile crisis intervention services continue into a second calendar day, a mental health professional must contact the client face-to-face on the second day to provide services and update the crisis treatment plan. The on-site observation must be documented in the client's record and signed by the mental health professional.

Subd. 10.

Client record.

The provider must maintain a file for each client that complies with the requirements under section 256B.0943, subdivision 11, and contains the following information:

(1) individual crisis treatment plans signed by the recipient, mental health professional, and mental health practitioner who developed the crisis treatment plan, or if the recipient refused to sign the plan, the date and reason stated by the recipient for not signing the plan;

(2) signed release of information forms;

(3) recipient health information and current medications;

(4) emergency contacts for the recipient;

(5) case records that document the date of service, place of service delivery, signature of the person providing the service, and the nature, extent, and units of service. Direct or telephone contact with the recipient's family or others should be documented;

(6) required clinical supervision by mental health professionals;

(7) summary of the recipient's case reviews by staff; and

(8) any written information by the recipient that the recipient wants in the file.

Subd. 11.

Excluded services.

The following services are excluded from reimbursement under this section:

(1) room and board services;

(2) services delivered to a recipient while admitted to an inpatient hospital;

(3) transportation services under children's mental health crisis response service;

(4) services provided and billed by a provider who is not enrolled under medical assistance to provide children's mental health crisis response services;

(5) crisis response services provided by a residential treatment center to clients in their facility;

(6) services performed by volunteers;

(7) direct billing of time spent "on call" when not delivering services to a recipient;

(8) provider service time included in case management reimbursement;

(9) outreach services to potential recipients; and

(10) a mental health service that is not medically necessary.

256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.

Subd. 5.

Service authorization.

The commissioner will administer authorizations for services under this section in compliance with section 256B.0625, subdivision 25.

256B.097 STATE QUALITY ASSURANCE, QUALITY IMPROVEMENT, AND LICENSING SYSTEM.

Subdivision 1.

Scope.

(a) In order to improve the quality of services provided to Minnesotans with disabilities and to meet the requirements of the federally approved home and community-based waivers under section 1915c of the Social Security Act, a State Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving disability services is enacted. This system is a partnership between the Department of Human Services and the State Quality Council established under subdivision 3.

(b) This system is a result of the recommendations from the Department of Human Services' licensing and alternative quality assurance study mandated under Laws 2005, First Special Session chapter 4, article 7, section 57, and presented to the legislature in February 2007.

(c) The disability services eligible under this section include:

(1) the home and community-based services waiver programs for persons with developmental disabilities under section 256B.092, subdivision 4, or section 256B.49, including brain injuries and services for those who qualify for nursing facility level of care or hospital facility level of care and any other services licensed under chapter 245D;

(2) home care services under section 256B.0651;

(3) family support grants under section 252.32;

(4) consumer support grants under section 256.476;

(5) semi-independent living services under section 252.275; and

(6) services provided through an intermediate care facility for the developmentally disabled.

(d) For purposes of this section, the following definitions apply:

(1) "commissioner" means the commissioner of human services;

(2) "council" means the State Quality Council under subdivision 3;

(3) "Quality Assurance Commission" means the commission under section 256B.0951; and

(4) "system" means the State Quality Assurance, Quality Improvement and Licensing System under this section.

Subd. 2.

Duties of commissioner of human services.

(a) The commissioner of human services shall establish the State Quality Council under subdivision 3.

(b) The commissioner shall initially delegate authority to perform licensing functions and activities according to section 245A.16 to a host county in Region 10. The commissioner must not license or reimburse a participating facility, program, or service located in Region 10 if the commissioner has received notification from the host county that the facility, program, or service has failed to qualify for licensure.

(c) The commissioner may conduct random licensing inspections based on outcomes adopted under section 256B.0951, subdivision 3, at facilities or programs, and of services eligible under this section. The role of the random inspections is to verify that the system protects the safety and well-being of persons served and maintains the availability of high-quality services for persons with disabilities.

(d) The commissioner shall ensure that the federal home and community-based waiver requirements are met and that incidents that may have jeopardized safety and health or violated services-related assurances, civil and human rights, and other protections designed to prevent abuse, neglect, and exploitation, are reviewed, investigated, and acted upon in a timely manner.

(e) The commissioner shall seek a federal waiver by July 1, 2012, to allow intermediate care facilities for persons with developmental disabilities to participate in this system.

Subd. 3.

State Quality Council.

(a) There is hereby created a State Quality Council which must define regional quality councils, and carry out a community-based, person-directed quality review component, and a comprehensive system for effective incident reporting, investigation, analysis, and follow-up.

(b) By August 1, 2011, the commissioner of human services shall appoint the members of the initial State Quality Council. Members shall include representatives from the following groups:

(1) disability service recipients and their family members;

(2) during the first four years of the State Quality Council, there must be at least three members from the Region 10 stakeholders. As regional quality councils are formed under subdivision 4, each regional quality council shall appoint one member;

(3) disability service providers;

(4) disability advocacy groups; and

(5) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.

(c) Members of the council who do not receive a salary or wages from an employer for time spent on council duties may receive a per diem payment when performing council duties and functions.

(d) The State Quality Council shall:

(1) assist the Department of Human Services in fulfilling federally mandated obligations by monitoring disability service quality and quality assurance and improvement practices in Minnesota;

(2) establish state quality improvement priorities with methods for achieving results and provide an annual report to the legislative committees with jurisdiction over policy and funding of disability services on the outcomes, improvement priorities, and activities undertaken by the commission during the previous state fiscal year;

(3) identify issues pertaining to financial and personal risk that impede Minnesotans with disabilities from optimizing choice of community-based services; and

(4) recommend to the chairs and ranking minority members of the legislative committees with jurisdiction over human services and civil law by January 15, 2014, statutory and rule changes related to the findings under clause (3) that promote individualized service and housing choices balanced with appropriate individualized protection.

(e) The State Quality Council, in partnership with the commissioner, shall:

(1) approve and direct implementation of the community-based, person-directed system established in this section;

(2) recommend an appropriate method of funding this system, and determine the feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;

(3) approve measurable outcomes in the areas of health and safety, consumer evaluation, education and training, providers, and systems;

(4) establish variable licensure periods not to exceed three years based on outcomes achieved; and

(5) in cooperation with the Quality Assurance Commission, design a transition plan for licensed providers from Region 10 into the alternative licensing system.

(f) The State Quality Council shall notify the commissioner of human services that a facility, program, or service has been reviewed by quality assurance team members under subdivision 4, paragraph (b), clause (13), and qualifies for a license.

(g) The State Quality Council, in partnership with the commissioner, shall establish an ongoing review process for the system. The review shall take into account the comprehensive nature of the system which is designed to evaluate the broad spectrum of licensed and unlicensed entities that provide services to persons with disabilities. The review shall address efficiencies and effectiveness of the system.

(h) The State Quality Council may recommend to the commissioner certain variances from the standards governing licensure of programs for persons with disabilities in order to improve the quality of services so long as the recommended variances do not adversely affect the health or safety of persons being served or compromise the qualifications of staff to provide services.

(i) The safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make recommendations to the commissioner or to the legislature in the report required under paragraph (c) regarding alternatives or modifications to the safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c).

(j) The State Quality Council may hire staff to perform the duties assigned in this subdivision.

Subd. 4.

Regional quality councils.

(a) The commissioner shall establish, as selected by the State Quality Council, regional quality councils of key stakeholders, including regional representatives of:

(1) disability service recipients and their family members;

(2) disability service providers;

(3) disability advocacy groups; and

(4) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.

(b) Each regional quality council shall:

(1) direct and monitor the community-based, person-directed quality assurance system in this section;

(2) approve a training program for quality assurance team members under clause (13);

(3) review summary reports from quality assurance team reviews and make recommendations to the State Quality Council regarding program licensure;

(4) make recommendations to the State Quality Council regarding the system;

(5) resolve complaints between the quality assurance teams, counties, providers, persons receiving services, their families, and legal representatives;

(6) analyze and review quality outcomes and critical incident data reporting incidents of life safety concerns immediately to the Department of Human Services licensing division;

(7) provide information and training programs for persons with disabilities and their families and legal representatives on service options and quality expectations;

(8) disseminate information and resources developed to other regional quality councils;

(9) respond to state-level priorities;

(10) establish regional priorities for quality improvement;

(11) submit an annual report to the State Quality Council on the status, outcomes, improvement priorities, and activities in the region;

(12) choose a representative to participate on the State Quality Council and assume other responsibilities consistent with the priorities of the State Quality Council; and

(13) recruit, train, and assign duties to members of quality assurance teams, taking into account the size of the service provider, the number of services to be reviewed, the skills necessary for the team members to complete the process, and ensure that no team member has a financial, personal, or family relationship with the facility, program, or service being reviewed or with anyone served at the facility, program, or service. Quality assurance teams must be comprised of county staff, persons receiving services or the person's families, legal representatives, members of advocacy organizations, providers, and other involved community members. Team members must complete the training program approved by the regional quality council and must demonstrate performance-based competency. Team members may be paid a per diem and reimbursed for expenses related to their participation in the quality assurance process.

(c) The commissioner shall monitor the safety standards, rights, and procedural protections for the monitoring of psychotropic medications and those identified under sections 245.825; 245.91 to 245.97; 245A.09, subdivision 2, paragraph (c), clauses (2) and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivision 1b, clause (7); and 626.557; and chapter 260E.

(d) The regional quality councils may hire staff to perform the duties assigned in this subdivision.

(e) The regional quality councils may charge fees for their services.

(f) The quality assurance process undertaken by a regional quality council consists of an evaluation by a quality assurance team of the facility, program, or service. The process must include an evaluation of a random sample of persons served. The sample must be representative of each service provided. The sample size must be at least five percent but not less than two persons served. All persons must be given the opportunity to be included in the quality assurance process in addition to those chosen for the random sample.

(g) A facility, program, or service may contest a licensing decision of the regional quality council as permitted under chapter 245A.

Subd. 5.

Annual survey of service recipients.

The commissioner, in consultation with the State Quality Council, shall conduct an annual independent statewide survey of service recipients, randomly selected, to determine the effectiveness and quality of disability services. The survey must be consistent with the system performance expectations of the Centers for Medicare and Medicaid Services (CMS) Quality Framework. The survey must analyze whether desired outcomes for persons with different demographic, diagnostic, health, and functional needs, who are receiving different types of services in different settings and with different costs, have been achieved. Annual statewide and regional reports of the results must be published and used to assist regions, counties, and providers to plan and measure the impact of quality improvement activities.

Subd. 6.

Mandated reporters.

Members of the State Quality Council under subdivision 3, the regional quality councils under subdivision 4, and quality assurance team members under subdivision 4, paragraph (b), clause (13), are mandated reporters as defined in sections 260E.06, subdivision 1, and 626.5572, subdivision 16.

256B.49 HOME AND COMMUNITY-BASED SERVICE WAIVERS FOR PERSONS WITH DISABILITIES.

Subd. 26.

Excess allocations.

Effective July 1, 2018, county and tribal agencies will be responsible for spending in excess of the annual allocation made by the commissioner. In the event a county or tribal agency spends in excess of the allocation made by the commissioner for a given allocation period, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The plan must state the actions the agency will take to correct its overspending for the two years following the period when the overspending occurred. The commissioner shall recoup funds spent in excess of the allocation only in cases when statewide spending exceeds the appropriation designated for the home and community-based services waivers. Nothing in this subdivision shall be construed as reducing the county or tribe's responsibility to offer and make available feasible home and community-based options to eligible waiver recipients within the resources allocated to it for that purpose.

Subd. 27.

Use of waiver allocations.

(a) Effective until June 30, 2018, county and tribal agencies are responsible for authorizing the annual allocation made by the commissioner. In the event a county or tribal agency authorizes less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services.

(b) Effective July 1, 2018, county and tribal agencies are responsible for spending the annual allocation made by the commissioner. In the event a county or tribal agency spends less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services.

(c) If a county or tribe does not submit a plan when required or implement the changes required, the commissioner shall assure access to waiver services within the county or tribe's available allocation, and take other actions needed to assure that all waiver participants in that county or tribe are receiving appropriate waiver services to meet their needs.

256D.051 SNAP EMPLOYMENT AND TRAINING PROGRAM.

Subdivision 1.

SNAP employment and training program.

The commissioner shall implement a SNAP employment and training program in order to meet the SNAP employment and training participation requirements of the United States Department of Agriculture. Unless exempt under subdivision 3a, each adult recipient in the unit must participate in the SNAP employment and training program each month that the person is eligible for SNAP benefits. The person's participation in SNAP employment and training services must begin no later than the first day of the calendar month following the determination of eligibility for SNAP benefits. With the county agency's consent, and to the extent of available resources, the person may voluntarily continue to participate in SNAP employment and training services for up to three additional consecutive months immediately following termination of SNAP benefits in order to complete the provisions of the person's employability development plan.

Subd. 1a.

Notices and sanctions.

(a) At the time the county agency notifies the household that it is eligible for SNAP benefits, the county agency must inform all mandatory employment and training services participants as identified in subdivision 1 in the household that they must comply with all SNAP employment and training program requirements each month, including the requirement to attend an initial orientation to the SNAP employment and training program and that SNAP eligibility will end unless the participants comply with the requirements specified in the notice.

(b) A participant who fails without good cause to comply with SNAP employment and training program requirements of this section, including attendance at orientation, will lose SNAP eligibility for the following periods:

(1) for the first occurrence, for one month or until the person complies with the requirements not previously complied with, whichever is longer;

(2) for the second occurrence, for three months or until the person complies with the requirements not previously complied with, whichever is longer; or

(3) for the third and any subsequent occurrence, for six months or until the person complies with the requirements not previously complied with, whichever is longer.

If the participant is not the SNAP head of household, the person shall be considered an ineligible household member for SNAP purposes. If the participant is the SNAP head of household, the entire household is ineligible for SNAP as provided in Code of Federal Regulations, title 7, section 273.7(g). "Good cause" means circumstances beyond the control of the participant, such as illness or injury, illness or injury of another household member requiring the participant's presence, a household emergency, or the inability to obtain child care for children between the ages of six and 12 or to obtain transportation needed in order for the participant to meet the SNAP employment and training program participation requirements.

(c) The county agency shall mail or hand deliver a notice to the participant not later than five days after determining that the participant has failed without good cause to comply with SNAP employment and training program requirements which specifies the requirements that were not complied with, the factual basis for the determination of noncompliance, and the right to reinstate eligibility upon a showing of good cause for failure to meet the requirements. The notice must ask the reason for the noncompliance and identify the participant's appeal rights. The notice must request that the participant inform the county agency if the participant believes that good cause existed for the failure to comply and must state that the county agency intends to terminate eligibility for SNAP benefits due to failure to comply with SNAP employment and training program requirements.

(d) If the county agency determines that the participant did not comply during the month with all SNAP employment and training program requirements that were in effect, and if the county agency determines that good cause was not present, the county must provide a ten-day notice of termination of SNAP benefits. The amount of SNAP benefits that are withheld from the household and determination of the impact of the sanction on other household members is governed by Code of Federal Regulations, title 7, section 273.7.

(e) The participant may appeal the termination of SNAP benefits under the provisions of section 256.045.

Subd. 2.

County agency duties.

(a) The county agency shall provide to SNAP benefit recipients a SNAP employment and training program. The program must include:

(1) orientation to the SNAP employment and training program;

(2) an individualized employability assessment and an individualized employability development plan that includes assessment of literacy, ability to communicate in the English language, educational and employment history, and that estimates the length of time it will take the participant to obtain employment. The employability assessment and development plan must be completed in consultation with the participant, must assess the participant's assets, barriers, and strengths, and must identify steps necessary to overcome barriers to employment. A copy of the employability development plan must be provided to the registrant;

(3) referral to available accredited remedial or skills training programs designed to address participant's barriers to employment;

(4) referral to available programs that provide subsidized or unsubsidized employment as necessary;

(5) a job search program, including job seeking skills training; and

(6) other activities, to the extent of available resources designed by the county agency to prepare the participant for permanent employment.

In order to allow time for job search, the county agency may not require an individual to participate in the SNAP employment and training program for more than 32 hours a week. The county agency shall require an individual to spend at least eight hours a week in job search or other SNAP employment and training program activities.

(b) The county agency shall prepare an annual plan for the operation of its SNAP employment and training program. The plan must be submitted to and approved by the commissioner of employment and economic development. The plan must include:

(1) a description of the services to be offered by the county agency;

(2) a plan to coordinate the activities of all public entities providing employment-related services in order to avoid duplication of effort and to provide services more efficiently;

(3) a description of the factors that will be taken into account when determining a client's employability development plan; and

(4) provisions to ensure that the county agency's employment and training service provider provides each recipient with an orientation, employability assessment, and employability development plan as specified in paragraph (a), clauses (1) and (2), within 30 days of the recipient's eligibility for assistance.

Subd. 2a.

Duties of commissioner.

In addition to any other duties imposed by law, the commissioner shall:

(1) based on this section and section 256D.052 and Code of Federal Regulations, title 7, section 273.7, supervise the administration of SNAP employment and training services to county agencies;

(2) disburse money appropriated for SNAP employment and training services to county agencies based upon the county's costs as specified in section 256D.051, subdivision 6c;

(3) accept and supervise the disbursement of any funds that may be provided by the federal government or from other sources for use in this state for SNAP employment and training services;

(4) cooperate with other agencies including any agency of the United States or of another state in all matters concerning the powers and duties of the commissioner under this section and section 256D.052; and

(5) in cooperation with the commissioner of employment and economic development, ensure that each component of an employment and training program carried out under this section is delivered through a statewide workforce development system, unless the component is not available locally through such a system.

Subd. 3.

Participant duties.

In order to receive SNAP assistance, a registrant shall: (1) cooperate with the county agency in all aspects of the SNAP employment and training program; (2) accept any suitable employment, including employment offered through the Job Training Partnership Act, and other employment and training options; and (3) participate in SNAP employment and training activities assigned by the county agency. The county agency may terminate assistance to a registrant who fails to cooperate in the SNAP employment and training program, as provided in subdivision 1a.

Subd. 3a.

Requirement to register work.

(a) To the extent required under Code of Federal Regulations, title 7, section 273.7(a), each applicant for and recipient of SNAP benefits is required to register for work as a condition of eligibility for SNAP benefits. Applicants and recipients are registered by signing an application or annual reapplication for SNAP benefits, and must be informed that they are registering for work by signing the form.

(b) The commissioner shall determine, within federal requirements, persons required to participate in the SNAP employment and training program.

(c) The following SNAP benefit recipients are exempt from mandatory participation in SNAP employment and training services:

(1) recipients of benefits under the Minnesota family investment program, Minnesota supplemental aid program, or the general assistance program;

(2) a child;

(3) a recipient over age 55;

(4) a recipient who has a mental or physical illness, injury, or incapacity which is expected to continue for at least 30 days and which impairs the recipient's ability to obtain or retain employment as evidenced by professional certification or the receipt of temporary or permanent disability benefits issued by a private or government source;

(5) a parent or other household member responsible for the care of either a dependent child in the household who is under age six or a person in the household who is professionally certified as having a physical or mental illness, injury, or incapacity. Only one parent or other household member may claim exemption under this provision;

(6) a recipient receiving unemployment insurance or who has applied for unemployment insurance and has been required to register for work with the Department of Employment and Economic Development as part of the unemployment insurance application process;

(7) a recipient participating each week in a drug addiction or alcohol abuse treatment and rehabilitation program, provided the operators of the treatment and rehabilitation program, in consultation with the county agency, recommend that the recipient not participate in the SNAP employment and training program;

(8) a recipient employed or self-employed for 30 or more hours per week at employment paying at least minimum wage, or who earns wages from employment equal to or exceeding 30 hours multiplied by the federal minimum wage; or

(9) a student enrolled at least half time in any school, training program, or institution of higher education. When determining if a student meets this criteria, the school's, program's or institution's criteria for being enrolled half time shall be used.

Subd. 3b.

Orientation.

The county agency or its employment and training service provider must provide an orientation to SNAP employment and training services to each nonexempt SNAP benefit recipient within 30 days of the date that SNAP eligibility is determined. The orientation must inform the participant of the requirement to participate in services, the date, time, and address to report to for services, the name and telephone number of the SNAP employment and training service provider, the consequences for failure without good cause to comply, the services and support services available through SNAP employment and training services and other providers of similar services, and must encourage the participant to view the SNAP benefits program as a temporary means of supplementing the family's food needs until the family achieves self-sufficiency through employment. The orientation may be provided through audio-visual methods, but the participant must have the opportunity for face-to-face interaction with county agency staff.

Subd. 6b.

Federal reimbursement.

(a) Federal financial participation from the United States Department of Agriculture for SNAP employment and training expenditures that are eligible for reimbursement through the SNAP employment and training program are dedicated funds and are annually appropriated to the commissioner of human services for the operation of the SNAP employment and training program.

(b) The appropriation must be used for skill attainment through employment, training, and support services for SNAP participants.

(c) Federal financial participation for the nonstate portion of SNAP employment and training costs must be paid to the county agency or service provider that incurred the costs.

Subd. 6c.

Program funding.

Within the limits of available resources, the commissioner shall reimburse the actual costs of county agencies and their employment and training service providers for the provision of SNAP employment and training services, including participant support services, direct program services, and program administrative activities. The cost of services for each county's SNAP employment and training program shall not exceed the annual allocated amount. No more than 15 percent of program funds may be used for administrative activities. The county agency may expend county funds in excess of the limits of this subdivision without state reimbursement.

Program funds shall be allocated based on the county's average number of SNAP eligible cases as compared to the statewide total number of such cases. The average number of cases shall be based on counts of cases as of March 31, June 30, September 30, and December 31 of the previous calendar year. The commissioner may reallocate unexpended money appropriated under this section to those county agencies that demonstrate a need for additional funds.

Subd. 7.

Registrant status.

A registrant under this section is not an employee for the purposes of workers' compensation, unemployment benefits, retirement, or civil service laws, and shall not perform work ordinarily performed by a regular public employee.

Subd. 8.

Voluntary quit.

A person who is required to participate in SNAP employment and training services is not eligible for SNAP benefits if, without good cause, the person refuses a legitimate offer of, or quits, suitable employment within 60 days before the date of application. A person who is required to participate in SNAP employment and training services and, without good cause, voluntarily quits suitable employment or refuses a legitimate offer of suitable employment while receiving SNAP benefits shall be terminated from the SNAP program as specified in subdivision 1a.

Subd. 9.

Subcontractors.

A county agency may, at its option, subcontract any or all of the duties under this section to a public or private entity approved by the commissioner of employment and economic development.

Subd. 18.

Work experience placements.

(a) To the extent of available resources, each county agency must establish and operate a work experience component in the SNAP employment and training program for recipients who are subject to a federal limit of three months of SNAP eligibility in any 36-month period. The purpose of the work experience component is to enhance the participant's employability, self-sufficiency, and to provide meaningful, productive work activities.

(b) The commissioner shall assist counties in the design and implementation of these components. The commissioner must ensure that job placements under a work experience component comply with section 256J.72. Written or oral concurrence with job duties of persons placed under the community work experience program shall be obtained from the appropriate exclusive bargaining representative.

(c) Worksites developed under this section are limited to projects that serve a useful public service such as health, social service, environmental protection, education, urban and rural development and redevelopment, welfare, recreation, public facilities, public safety, community service, services to aged citizens or citizens with a disability, and child care. To the extent possible, the prior training, skills, and experience of a recipient must be used in making appropriate work experience assignments.

(d) Structured, supervised volunteer work with an agency or organization that is monitored by the county service provider may, with the approval of the county agency, be used as a work experience placement.

(e) As a condition of placing a person receiving SNAP benefits in a program under this subdivision, the county agency shall first provide the recipient the opportunity:

(1) for placement in suitable subsidized or unsubsidized employment through participation in job search under section 256D.051; or

(2) for placement in suitable employment through participation in on-the-job training, if such employment is available.

(f) The county agency shall limit the maximum monthly number of hours that any participant may work in a work experience placement to a number equal to the amount of the family's monthly SNAP benefit allotment divided by the greater of the federal minimum wage or the applicable state minimum wage.

After a participant has been assigned to a position for nine months, the participant may not continue in that assignment unless the maximum number of hours a participant works is no greater than the amount of the SNAP benefit divided by the rate of pay for individuals employed in the same or similar occupations by the same employer at the same site.

(g) The participant's employability development plan must include the length of time needed in the work experience program, the need to continue job seeking activities while participating in work experience, and the participant's employment goals.

(h) After each six months of a recipient's participation in a work experience job placement, and at the conclusion of each work experience assignment under this section, the county agency shall reassess and revise, as appropriate, the participant's employability development plan.

(i) A participant has good cause for failure to cooperate with a work experience job placement if, in the judgment of the employment and training service provider, the reason for failure is reasonable and justified. Good cause for purposes of this section is defined in subdivision 1a, paragraph (b).

(j) A recipient who has failed without good cause to participate in or comply with the work experience job placement shall be terminated from participation in work experience job activities. If the recipient is not exempt from mandatory SNAP employment and training program participation under subdivision 3a, the recipient will be assigned to other mandatory program activities. If the recipient is exempt from mandatory participation but is participating as a volunteer, the person shall be terminated from the SNAP employment and training program.

256D.052 LITERACY TRAINING FOR RECIPIENTS.

Subd. 3.

Participant literacy transportation costs.

Within the limits of the state appropriation the county agency must provide transportation to enable Supplemental Nutrition Assistance Program (SNAP) employment and training participants to participate in literacy training under this section. The state shall reimburse county agencies for the costs of providing transportation under this section up to the amount of the state appropriation. Counties must make every effort to ensure that child care is available as needed by recipients who are pursuing literacy training.

256J.08 DEFINITIONS.

Subd. 10.

Budget month.

"Budget month" means the calendar month which the county agency uses to determine the income or circumstances of an assistance unit to calculate the amount of the assistance payment in the payment month.

Subd. 53.

Lump sum.

"Lump sum" means nonrecurring income that is not excluded in section 256J.21.

Subd. 61.

Monthly income test.

"Monthly income test" means the test used to determine ongoing eligibility and the assistance payment amount according to section 256J.21.

Subd. 62.

Nonrecurring income.

"Nonrecurring income" means a form of income which is received:

(1) only one time or is not of a continuous nature; or

(2) in a prospective payment month but is no longer received in the corresponding retrospective payment month.

Subd. 81.

Retrospective budgeting.

"Retrospective budgeting" means a method of determining the amount of the assistance payment in which the payment month is the second month after the budget month.

Subd. 83.

Significant change.

"Significant change" means a decline in gross income of the amount of the disregard as defined in section 256P.03 or more from the income used to determine the grant for the current month.

256J.30 APPLICANT AND PARTICIPANT REQUIREMENTS AND RESPONSIBILITIES.

Subd. 5.

Monthly MFIP household reports.

Each assistance unit with a member who has earned income or a recent work history, and each assistance unit that has income deemed to it from a financially responsible person must complete a monthly MFIP household report form. "Recent work history" means the individual received earned income in the report month or any of the previous three calendar months even if the earnings are excluded. To be complete, the MFIP household report form must be signed and dated by the caregivers no earlier than the last day of the reporting period. All questions required to determine assistance payment eligibility must be answered, and documentation of earned income must be included.

Subd. 7.

Due date of MFIP household report form.

An MFIP household report form must be received by the county agency by the eighth calendar day of the month following the reporting period covered by the form. When the eighth calendar day of the month falls on a weekend or holiday, the MFIP household report form must be received by the county agency the first working day that follows the eighth calendar day.

Subd. 8.

Late MFIP household report forms.

(a) Paragraphs (b) to (e) apply to the reporting requirements in subdivision 7.

(b) When the county agency receives an incomplete MFIP household report form, the county agency must immediately return the incomplete form and clearly state what the caregiver must do for the form to be complete.

(c) The automated eligibility system must send a notice of proposed termination of assistance to the assistance unit if a complete MFIP household report form is not received by a county agency. The automated notice must be mailed to the caregiver by approximately the 16th of the month. When a caregiver submits an incomplete form on or after the date a notice of proposed termination has been sent, the termination is valid unless the caregiver submits a complete form before the end of the month.

(d) An assistance unit required to submit an MFIP household report form is considered to have continued its application for assistance if a complete MFIP household report form is received within a calendar month after the month in which the form was due and assistance shall be paid for the period beginning with the first day of that calendar month.

(e) A county agency must allow good cause exemptions from the reporting requirements under subdivision 5 when any of the following factors cause a caregiver to fail to provide the county agency with a completed MFIP household report form before the end of the month in which the form is due:

(1) an employer delays completion of employment verification;

(2) a county agency does not help a caregiver complete the MFIP household report form when the caregiver asks for help;

(3) a caregiver does not receive an MFIP household report form due to mistake on the part of the department or the county agency or due to a reported change in address;

(4) a caregiver is ill, or physically or mentally incapacitated; or

(5) some other circumstance occurs that a caregiver could not avoid with reasonable care which prevents the caregiver from providing a completed MFIP household report form before the end of the month in which the form is due.

256J.33 PROSPECTIVE AND RETROSPECTIVE MFIP ELIGIBILITY.

Subd. 3.

Retrospective eligibility.

After the first two months of MFIP eligibility, a county agency must continue to determine whether an assistance unit is prospectively eligible for the payment month by looking at all factors other than income and then determine whether the assistance unit is retrospectively income eligible by applying the monthly income test to the income from the budget month. When the monthly income test is not satisfied, the assistance payment must be suspended when ineligibility exists for one month or ended when ineligibility exists for more than one month.

Subd. 4.

Monthly income test.

A county agency must apply the monthly income test retrospectively for each month of MFIP eligibility. An assistance unit is not eligible when the countable income equals or exceeds the MFIP standard of need or the family wage level for the assistance unit. The income applied against the monthly income test must include:

(1) gross earned income from employment, prior to mandatory payroll deductions, voluntary payroll deductions, wage authorizations, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36, unless the employment income is specifically excluded under section 256J.21, subdivision 2;

(2) gross earned income from self-employment less deductions for self-employment expenses in section 256J.37, subdivision 5, but prior to any reductions for personal or business state and federal income taxes, personal FICA, personal health and life insurance, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36;

(3) unearned income after deductions for allowable expenses in section 256J.37, subdivision 9, and allocations in section 256J.36, unless the income has been specifically excluded in section 256J.21, subdivision 2;

(4) gross earned income from employment as determined under clause (1) which is received by a member of an assistance unit who is a minor child or minor caregiver and less than a half-time student;

(5) child support received by an assistance unit, excluded under section 256J.21, subdivision 2, clause (49), or section 256P.06, subdivision 3, clause (2), item (xvi);

(6) spousal support received by an assistance unit;

(7) the income of a parent when that parent is not included in the assistance unit;

(8) the income of an eligible relative and spouse who seek to be included in the assistance unit; and

(9) the unearned income of a minor child included in the assistance unit.

Subd. 5.

When to terminate assistance.

When an assistance unit is ineligible for MFIP assistance for two consecutive months, the county agency must terminate MFIP assistance.

256J.34 CALCULATING ASSISTANCE PAYMENTS.

Subdivision 1.

Prospective budgeting.

A county agency must use prospective budgeting to calculate the assistance payment amount for the first two months for an applicant who has not received assistance in this state for at least one payment month preceding the first month of payment under a current application. Notwithstanding subdivision 3, paragraph (a), clause (2), a county agency must use prospective budgeting for the first two months for a person who applies to be added to an assistance unit. Prospective budgeting is not subject to overpayments or underpayments unless fraud is determined under section 256.98.

(a) The county agency must apply the income received or anticipated in the first month of MFIP eligibility against the need of the first month. The county agency must apply the income received or anticipated in the second month against the need of the second month.

(b) When the assistance payment for any part of the first two months is based on anticipated income, the county agency must base the initial assistance payment amount on the information available at the time the initial assistance payment is made.

(c) The county agency must determine the assistance payment amount for the first two months of MFIP eligibility by budgeting both recurring and nonrecurring income for those two months.

Subd. 2.

Retrospective budgeting.

The county agency must use retrospective budgeting to calculate the monthly assistance payment amount after the payment for the first two months has been made under subdivision 1.

Subd. 3.

Additional uses of retrospective budgeting.

Notwithstanding subdivision 1, the county agency must use retrospective budgeting to calculate the monthly assistance payment amount for the first two months under paragraphs (a) and (b).

(a) The county agency must use retrospective budgeting to determine the amount of the assistance payment in the first two months of MFIP eligibility:

(1) when an assistance unit applies for assistance for the same month for which assistance has been interrupted, the interruption in eligibility is less than one payment month, the assistance payment for the preceding month was issued in this state, and the assistance payment for the immediately preceding month was determined retrospectively; or

(2) when a person applies in order to be added to an assistance unit, that assistance unit has received assistance in this state for at least the two preceding months, and that person has been living with and has been financially responsible for one or more members of that assistance unit for at least the two preceding months.

(b) Except as provided in clauses (1) to (4), the county agency must use retrospective budgeting and apply income received in the budget month by an assistance unit and by a financially responsible household member who is not included in the assistance unit against the MFIP standard of need or family wage level to determine the assistance payment to be issued for the payment month.

(1) When a source of income ends prior to the third payment month, that income is not considered in calculating the assistance payment for that month. When a source of income ends prior to the fourth payment month, that income is not considered when determining the assistance payment for that month.

(2) When a member of an assistance unit or a financially responsible household member leaves the household of the assistance unit, the income of that departed household member is not budgeted retrospectively for any full payment month in which that household member does not live with that household and is not included in the assistance unit.

(3) When an individual is removed from an assistance unit because the individual is no longer a minor child, the income of that individual is not budgeted retrospectively for payment months in which that individual is not a member of the assistance unit, except that income of an ineligible child in the household must continue to be budgeted retrospectively against the child's needs when the parent or parents of that child request allocation of their income against any unmet needs of that ineligible child.

(4) When a person ceases to have financial responsibility for one or more members of an assistance unit, the income of that person is not budgeted retrospectively for the payment months which follow the month in which financial responsibility ends.

Subd. 4.

Significant change in gross income.

The county agency must recalculate the assistance payment when an assistance unit experiences a significant change, as defined in section 256J.08, resulting in a reduction in the gross income received in the payment month from the gross income received in the budget month. The county agency must issue a supplemental assistance payment based on the county agency's best estimate of the assistance unit's income and circumstances for the payment month. Supplemental assistance payments that result from significant changes are limited to two in a 12-month period regardless of the reason for the change. Notwithstanding any other statute or rule of law, supplementary assistance payments shall not be made when the significant change in income is the result of receipt of a lump sum, receipt of an extra paycheck, business fluctuation in self-employment income, or an assistance unit member's participation in a strike or other labor action.

256J.37 TREATMENT OF INCOME AND LUMP SUMS.

Subd. 10.

Treatment of lump sums.

(a) The agency must treat lump-sum payments as earned or unearned income. If the lump-sum payment is included in the category of income identified in subdivision 9, it must be treated as unearned income. A lump sum is counted as income in the month received and budgeted either prospectively or retrospectively depending on the budget cycle at the time of receipt. When an individual receives a lump-sum payment, that lump sum must be combined with all other earned and unearned income received in the same budget month, and it must be applied according to paragraphs (a) to (c). A lump sum may not be carried over into subsequent months. Any funds that remain in the third month after the month of receipt are counted in the asset limit.

(b) For a lump sum received by an applicant during the first two months, prospective budgeting is used to determine the payment and the lump sum must be combined with other earned or unearned income received and budgeted in that prospective month.

(c) For a lump sum received by a participant after the first two months of MFIP eligibility, the lump sum must be combined with other income received in that budget month, and the combined amount must be applied retrospectively against the applicable payment month.

(d) When a lump sum, combined with other income under paragraphs (b) and (c), is less than the MFIP transitional standard for the appropriate payment month, the assistance payment must be reduced according to the amount of the countable income. When the countable income is greater than the MFIP standard or family wage level, the assistance payment must be suspended for the payment month.

256L.11 PROVIDER PAYMENT.

Subd. 6a.

Dental providers.

Effective for dental services provided to MinnesotaCare enrollees on or after January 1, 2018, the commissioner shall increase payment rates to dental providers by 54 percent. Payments made to prepaid health plans under section 256L.12 shall reflect the payment increase described in this subdivision. The prepaid health plans under contract with the commissioner shall provide payments to dental providers that are at least equal to a rate that includes the payment rate specified in this subdivision, and if applicable to the provider, the rates described under subdivision 7.

Repealed Minnesota Rule: 21-02810

9505.0370 DEFINITIONS.

Subpart 1.

Scope.

For parts 9505.0370 to 9505.0372, the following terms have the meanings given them.

Subp. 2.

Adult day treatment.

"Adult day treatment" or "adult day treatment program" means a structured program of treatment and care.

Subp. 3.

Child.

"Child" means a person under 18 years of age.

Subp. 4.

Client.

"Client" means an eligible recipient who is determined to have or who is being assessed for a mental illness as specified in part 9505.0371.

Subp. 5.

Clinical summary.

"Clinical summary" means a written description of a clinician's formulation of the cause of the client's mental health symptoms, the client's prognosis, and the likely consequences of the symptoms; how the client meets the criteria for the diagnosis by describing the client's symptoms, the duration of symptoms, and functional impairment; an analysis of the client's other symptoms, strengths, relationships, life situations, cultural influences, and health concerns and their potential interaction with the diagnosis and formulation of the client's mental health condition; and alternative diagnoses that were considered and ruled out.

Subp. 6.

Clinical supervision.

"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.

Subp. 7.

Clinical supervisor.

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

Subp. 8.

Cultural competence or culturally competent.

"Cultural competence" or "culturally competent" means the mental health provider's:

A.

awareness of the provider's own cultural background, and the related assumptions, values, biases, and preferences that influence assessment and intervention processes;

B.

ability and will to respond to the unique needs of an individual client that arise from the client's culture;

C.

ability to utilize the client's culture as a resource and as a means to optimize mental health care; and

D.

willingness to seek educational, consultative, and learning experiences to expand knowledge of and increase effectiveness with culturally diverse populations.

Subp. 9.

Cultural influences.

"Cultural influences" means historical, geographical, and familial factors that affect assessment and intervention processes. Cultural influences that are relevant to the client may include the client's:

A.

racial or ethnic self-identification;

B.

experience of cultural bias as a stressor;

C.

immigration history and status;

D.

level of acculturation;

E.

time orientation;

F.

social orientation;

G.

verbal communication style;

H.

locus of control;

I.

spiritual beliefs; and

J.

health beliefs and the endorsement of or engagement in culturally specific healing practices.

Subp. 10.

Culture.

"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.

Subp. 11.

Diagnostic assessment.

"Diagnostic assessment" means a written assessment that documents a clinical and functional face-to-face evaluation of the client's mental health, including the nature, severity and impact of behavioral difficulties, functional impairment, and subjective distress of the client, and identifies the client's strengths and resources.

Subp. 12.

Dialectical behavior therapy.

"Dialectical behavior therapy" means an evidence-based treatment approach provided in an intensive outpatient treatment program using a combination of individualized rehabilitative and psychotherapeutic interventions. A dialectical behavior therapy program is certified by the commissioner and involves the following service components: individual dialectical behavior therapy, group skills training, telephone coaching, and team consultation meetings.

Subp. 13.

Explanation of findings.

"Explanation of findings" means the explanation of a client's diagnostic assessment, psychological testing, treatment program, and consultation with culturally informed mental health consultants as required under parts 9520.0900 to 9520.0926, or other accumulated data and recommendations to the client, client's family, primary caregiver, or other responsible persons.

Subp. 14.

Family.

"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, children, spouse, committed partners, former spouses, persons related by blood or adoption, or persons who are presently residing together as a family unit.

Subp. 15.

Individual treatment plan.

"Individual treatment plan" means a written plan that outlines and defines the course of treatment. It delineates the goals, measurable objectives, target dates for achieving specific goals, main participants in treatment process, and recommended services that are based on the client's diagnostic assessment and other meaningful data that are needed to aid the client's recovery and enhance resiliency.

Subp. 16.

Medication management.

"Medication management" means a service that determines the need for or effectiveness of the medication prescribed for the treatment of a client's symptoms of a mental illness.

Subp. 17.

Mental health practitioner.

"Mental health practitioner" means a person who is qualified according to part 9505.0371, subpart 5, items B and C, and provides mental health services to a client with a mental illness under the clinical supervision of a mental health professional.

Subp. 18.

Mental health professional.

"Mental health professional" means a person who is enrolled to provide medical assistance services and is qualified according to part 9505.0371, subpart 5, item A.

Subp. 19.

Mental health telemedicine.

"Mental health telemedicine" has the meaning given in Minnesota Statutes, section 256B.0625, subdivision 46.

Subp. 20.

Mental illness.

"Mental illness" has the meaning given in Minnesota Statutes, section 245.462, subdivision 20. "Mental illness" includes "emotional disturbance" as defined in Minnesota Statutes, section 245.4871, subdivision 15.

Subp. 21.

Multidisciplinary staff.

"Multidisciplinary staff" means a group of individuals from diverse disciplines who come together to provide services to clients under part 9505.0372, subparts 8, 9, and 10.

Subp. 22.

Neuropsychological assessment.

"Neuropsychological assessment" means a specialized clinical assessment of the client's underlying cognitive abilities related to thinking, reasoning, and judgment that is conducted by a qualified neuropsychologist.

Subp. 23.

Neuropsychological testing.

"Neuropsychological testing" means administering standardized tests and measures designed to evaluate the client's ability to attend to, process, interpret, comprehend, communicate, learn and recall information; and use problem-solving and judgment.

Subp. 24.

Partial hospitalization program.

"Partial hospitalization program" means a provider's time-limited, structured program of psychotherapy and other therapeutic services, as defined in United States Code, title 42, chapter 7, subchapter XVIII, part E, section 1395x, (ff), that is provided in an outpatient hospital facility or community mental health center that meets Medicare requirements to provide partial hospitalization services.

Subp. 25.

Primary caregiver.

"Primary caregiver" means a person, other than the facility staff, who has primary legal responsibility for providing the client with food, clothing, shelter, direction, guidance, and nurturance.

Subp. 26.

Psychological testing.

"Psychological testing" means the use of tests or other psychometric instruments to determine the status of the recipient's mental, intellectual, and emotional functioning.

Subp. 27.

Psychotherapy.

"Psychotherapy" means treatment of a client with mental illness that applies the most appropriate psychological, psychiatric, psychosocial, or interpersonal method that conforms to prevailing community standards of professional practice to meet the mental health needs of the client.

Subp. 28.

Supervisee.

"Supervisee" means an individual who requires clinical supervision because the individual does not meet mental health professional standards in part 9505.0371, subpart 5, item A.

9505.0371 MEDICAL ASSISTANCE COVERAGE REQUIREMENTS FOR OUTPATIENT MENTAL HEALTH SERVICES.

Subpart 1.

Purpose.

This part describes the requirements that outpatient mental health services must meet to receive medical assistance reimbursement.

Subp. 2.

Client eligibility for mental health services.

The following requirements apply to mental health services:

A.

The provider must use a diagnostic assessment as specified in part 9505.0372 to determine a client's eligibility for mental health services under this part, except:

(1)

prior to completion of a client's initial diagnostic assessment, a client is eligible for:

(a)

one explanation of findings;

(b)

one psychological testing; and

(c)

either one individual psychotherapy session, one family psychotherapy session, or one group psychotherapy session; and

(2)

for a client who is not currently receiving mental health services covered by medical assistance, a crisis assessment as specified in Minnesota Statutes, section 256B.0624 or 256B.0944, conducted in the past 60 days may be used to allow up to ten sessions of mental health services within a 12-month period.

B.

A brief diagnostic assessment must meet the requirements of part 9505.0372, subpart 1, item D, and:

(1)

may be used to allow up to ten sessions of mental health services as specified in part 9505.0372 within a 12-month period before a standard or extended diagnostic assessment is required when the client is:

(a)

a new client; or

(b)

an existing client who has had fewer than ten sessions of psychotherapy in the previous 12 months and is projected to need fewer than ten sessions of psychotherapy in the next 12 months, or who only needs medication management; and

(2)

may be used for a subsequent annual assessment, if based upon the client's treatment history and the provider's clinical judgment, the client will need ten or fewer sessions of mental health services in the upcoming 12-month period; and

(3)

must not be used for:

(a)

a client or client's family who requires a language interpreter to participate in the assessment unless the client meets the requirements of subitem (1), unit (b), or (2); or

(b)

more than ten sessions of mental health services in a 12-month period. If, after completion of ten sessions of mental health services, the mental health professional determines the need for additional sessions, a standard assessment or extended assessment must be completed.

C.

For a child, a new standard or extended diagnostic assessment must be completed:

(1)

when the child does not meet the criteria for a brief diagnostic assessment;

(2)

at least annually following the initial diagnostic assessment, if:

(a)

additional services are needed; and

(b)

the child does not meet criteria for brief assessment;

(3)

when the child's mental health condition has changed markedly since the child's most recent diagnostic assessment; or

(4)

when the child's current mental health condition does not meet criteria of the child's current diagnosis.

D.

For an adult, a new standard diagnostic assessment or extended diagnostic assessment must be completed:

(1)

when the adult does not meet the criteria for a brief diagnostic assessment or an adult diagnostic assessment update;

(2)

at least every three years following the initial diagnostic assessment for an adult who receives mental health services;

(3)

when the adult's mental health condition has changed markedly since the adult's most recent diagnostic assessment; or

(4)

when the adult's current mental health condition does not meet criteria of the current diagnosis.

E.

An adult diagnostic assessment update must be completed at least annually unless a new standard or extended diagnostic assessment is performed. An adult diagnostic assessment update must include an update of the most recent standard or extended diagnostic assessment and any recent adult diagnostic assessment updates that have occurred since the last standard or extended diagnostic assessment.

Subp. 3.

Authorization for mental health services.

Mental health services under this part are subject to authorization criteria and standards published by the commissioner according to Minnesota Statutes, section 256B.0625, subdivision 25.

Subp. 4.

Clinical supervision.

A.

Clinical supervision must be based on each supervisee's written supervision plan and must:

(1)

promote professional knowledge, skills, and values development;

(2)

model ethical standards of practice;

(3)

promote cultural competency by:

(a)

developing the supervisee's knowledge of cultural norms of behavior for individual clients and generally for the clients served by the supervisee regarding the client's cultural influences, age, class, gender, sexual orientation, literacy, and mental or physical disability;

(b)

addressing how the supervisor's and supervisee's own cultures and privileges affect service delivery;

(c)

developing the supervisee's ability to assess their own cultural competence and to identify when consultation or referral of the client to another provider is needed; and

(d)

emphasizing the supervisee's commitment to maintaining cultural competence as an ongoing process;

(4)

recognize that the client's family has knowledge about the client and will continue to play a role in the client's life and encourage participation among the client, client's family, and providers as treatment is planned and implemented; and

(5)

monitor, evaluate, and document the supervisee's performance of assessment, treatment planning, and service delivery.

B.

Clinical supervision must be conducted by a qualified supervisor using individual or group supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of part 9505.0370, subpart 19.

(1)

Individual supervision means one or more designated clinical supervisors and one supervisee.

(2)

Group supervision means one clinical supervisor and two to six supervisees in face-to-face supervision.

C.

The supervision plan must be developed by the supervisor and the supervisee. The plan must be reviewed and updated at least annually. For new staff the plan must be completed and implemented within 30 days of the new staff person's employment. The supervision plan must include:

(1)

the name and qualifications of the supervisee and the name of the agency in which the supervisee is being supervised;

(2)

the name, licensure, and qualifications of the supervisor;

(3)

the number of hours of individual and group supervision to be completed by the supervisee including whether supervision will be in person or by some other method approved by the commissioner;

(4)

the policy and method that the supervisee must use to contact the clinical supervisor during service provision to a supervisee;

(5)

procedures that the supervisee must use to respond to client emergencies; and

(6)

authorized scope of practices, including:

(a)

description of the supervisee's service responsibilities;

(b)

description of client population; and

(c)

treatment methods and modalities.

D.

Clinical supervision must be recorded in the supervisee's supervision record. The documentation must include:

(1)

date and duration of supervision;

(2)

identification of supervision type as individual or group supervision;

(3)

name of the clinical supervisor;

(4)

subsequent actions that the supervisee must take; and

(5)

date and signature of the clinical supervisor.

E.

Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the client record after supervision occurs.

Subp. 5.

Qualified providers.

Medical assistance covers mental health services according to part 9505.0372 when the services are provided by mental health professionals or mental health practitioners qualified under this subpart.

A.

A mental health professional must be qualified in one of the following ways:

(1)

in clinical social work, a person must be licensed as an independent clinical social worker by the Minnesota Board of Social Work under Minnesota Statutes, chapter 148D until August 1, 2011, and thereafter under Minnesota Statutes, chapter 148E;

(2)

in psychology, a person licensed by the Minnesota Board of Psychology under Minnesota Statutes, sections 148.88 to 148.98, who has stated to the board competencies in the diagnosis and treatment of mental illness;

(3)

in psychiatry, a physician licensed under Minnesota Statutes, chapter 147, who is certified by the American Board of Psychiatry and Neurology or is eligible for board certification;

(4)

in marriage and family therapy, a person licensed as a marriage and family therapist by the Minnesota Board of Marriage and Family Therapy under Minnesota Statutes, sections 148B.29 to 148B.39, and defined in parts 5300.0100 to 5300.0350;

(5)

in professional counseling, a person licensed as a professional clinical counselor by the Minnesota Board of Behavioral Health and Therapy under Minnesota Statutes, section 148B.5301;

(6)

a tribally approved mental health care professional, who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), and who is serving a federally recognized Indian tribe; or

(7)

in psychiatric nursing, a registered nurse who is licensed under Minnesota Statutes, sections 148.171 to 148.285, and meets one of the following criteria:

(a)

is certified as a clinical nurse specialist;

(b)

for children, is certified as a nurse practitioner in child or adolescent or family psychiatric and mental health nursing by a national nurse certification organization; or

(c)

for adults, is certified as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization.

B.

A mental health practitioner for a child client must have training working with children. A mental health practitioner for an adult client must have training working with adults. A mental health practitioner must be 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

(a)

has at least 2,000 hours of supervised experience in the delivery of mental health services to clients with mental illness; or

(b)

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

(2)

has at least 6,000 hours of supervised experience in the delivery of mental health services to clients with mental illness. Hours worked as a mental health behavioral aide I or II under Minnesota Statutes, section 256B.0943, subdivision 7, may be included in the 6,000 hours of experience for child clients;

(3)

is a graduate student in one of the mental health professional disciplines defined in item A and is formally assigned by an accredited college or university to an agency or facility for clinical training;

(4)

holds a master's or other graduate degree in one of the mental health professional disciplines defined in item A from an accredited college or university; or

(5)

is an individual who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), who is serving a federally recognized Indian tribe.

C.

Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy performed by a mental health practitioner working as a clinical trainee when:

(1)

the mental health practitioner is:

(a)

complying with requirements for licensure or board certification as a mental health professional, as defined in item A, including supervised practice in the delivery of mental health services for the treatment of mental illness; or

(b)

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 defined in item A; and

(2)

the mental health practitioner's clinical supervision experience is helping the practitioner gain knowledge and skills necessary to practice effectively and independently. This may include supervision of:

(a)

direct practice;

(b)

treatment team collaboration;

(c)

continued professional learning; and

(d)

job management.

D.

A clinical supervisor must:

(1)

be a mental health professional licensed as specified in item A;

(2)

hold a license without restrictions that has been in good standing for at least one year while having performed at least 1,000 hours of clinical practice;

(3)

be approved, certified, or in some other manner recognized as a qualified clinical supervisor by the person's professional licensing board, when this is a board requirement;

(4)

be competent as demonstrated by experience and graduate-level training in the area of practice and the activities being supervised;

(5)

not be the supervisee's blood or legal relative or cohabitant, or someone who has acted as the supervisee's therapist within the past two years;

(6)

have experience and skills that are informed by advanced training, years of experience, and mastery of a range of competencies that demonstrate the following:

(a)

capacity to provide services that incorporate best practice;

(b)

ability to recognize and evaluate competencies in supervisees;

(c)

ability to review assessments and treatment plans for accuracy and appropriateness;

(d)

ability to give clear direction to mental health staff related to alternative strategies when a client is struggling with moving towards recovery; and

(e)

ability to coach, teach, and practice skills with supervisees;

(7)

accept full professional liability for a supervisee's direction of a client's mental health services;

(8)

instruct a supervisee in the supervisee's work, and oversee the quality and outcome of the supervisee's work with clients;

(9)

review, approve, and sign the diagnostic assessment, individual treatment plans, and treatment plan reviews of clients treated by a supervisee;

(10)

review and approve the progress notes of clients treated by the supervisee according to the supervisee's supervision plan;

(11)

apply evidence-based practices and research-informed models to treat clients;

(12)

be employed by or under contract with the same agency as the supervisee;

(13)

develop a clinical supervision plan for each supervisee;

(14)

ensure that each supervisee receives the guidance and support needed to provide treatment services in areas where the supervisee practices;

(15)

establish an evaluation process that identifies the performance and competence of each supervisee; and

(16)

document clinical supervision of each supervisee and securely maintain the documentation record.

Subp. 6.

Release of information.

Providers who receive a request for client information and providers who request client information must:

A.

comply with data practices and medical records standards in Minnesota Statutes, chapter 13, and Code of Federal Regulations, title 45, part 164; and

B.

subject to the limitations in item A, promptly provide client information, including a written diagnostic assessment, to other providers who are treating the client to ensure that the client will get services without undue delay.

Subp. 7.

Individual treatment plan.

Except as provided in subpart 2, item A, subitem (1), a medical assistance payment is available only for services provided in accordance with the client's written individual treatment plan (ITP). The client must be involved in the development, review, and revision of the client's ITP. For all mental health services, except as provided in subpart 2, item A, subitem (1), and medication management, the ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP. In the case of a child, the child's parent, primary caregiver, or other person authorized by statute to consent to mental health services for the child shall be asked to sign the child's ITP and revisions of the ITP. If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal. A client's individual treatment plan must be:

A.

based on the client's current diagnostic assessment;

B.

developed by identifying the client's service needs and considering relevant cultural influences to identify planned interventions that contain specific treatment goals and measurable objectives for the client; and

C.

reviewed at least once every 90 days, and revised as necessary. Revisions to the initial individual treatment plan do not require a new diagnostic assessment unless the client's mental health status has changed markedly as provided in subpart 2.

Subp. 8.

Documentation.

To obtain medical assistance payment for an outpatient mental health service, a mental health professional or a mental health practitioner must promptly document:

A.

in the client's mental health record:

(1)

each occurrence of service to the client including the date, type of service, start and stop time, scope of the mental health service, name and title of the person who gave the service, and date of documentation; and

(2)

all diagnostic assessments and other assessments, psychological test results, treatment plans, and treatment plan reviews;

B.

the provider's contact with persons interested in the client such as representatives of the courts, corrections systems, or schools, or the client's other mental health providers, case manager, family, primary caregiver, legal representative, including the name and date of the contact or, if applicable, the reason the client's family, primary caregiver, or legal representative was not contacted; and

C.

dates that treatment begins and ends and reason for the discontinuation of the mental health service.

Subp. 9.

Service coordination.

The provider must coordinate client services as authorized by the client as follows:

A.

When a recipient receives mental health services from more than one mental health provider, each provider must coordinate mental health services they provide to the client with other mental health service providers to ensure services are provided in the most efficient manner to achieve maximum benefit for the client.

B.

The mental health provider must coordinate mental health care with the client's physical health provider.

Subp. 10.

Telemedicine services.

Mental health services in part 9505.0372 covered as direct face-to-face services may be provided via two-way interactive video if it is medically appropriate to the client's condition and needs. The interactive video equipment and connection must comply with Medicare standards that are in effect at the time of service. The commissioner may specify parameters within which mental health services can be provided via telemedicine.

9505.0372 COVERED SERVICES.

Subpart 1.

Diagnostic assessment.

Medical assistance covers four types of diagnostic assessments when they are provided in accordance with the requirements in this subpart.

A.

To be eligible for medical assistance payment, a diagnostic assessment must:

(1)

identify a mental health diagnosis and recommended mental health services, which are the factual basis to develop the recipient's mental health services and treatment plan; or

(2)

include a finding that the client does not meet the criteria for a mental health disorder.

B.

A standard diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The standard diagnostic assessment must be done within the cultural context of the client and must include relevant information about:

(1)

the client's current life situation, including the client's:

(a)

age;

(b)

current living situation, including household membership and housing status;

(c)

basic needs status including economic status;

(d)

education level and employment status;

(e)

significant personal relationships, including the client's evaluation of relationship quality;

(f)

strengths and resources, including the extent and quality of social networks;

(g)

belief systems;

(h)

contextual nonpersonal factors contributing to the client's presenting concerns;

(i)

general physical health and relationship to client's culture; and

(j)

current medications;

(2)

the reason for the assessment, including the client's:

(a)

perceptions of the client's condition;

(b)

description of symptoms, including reason for referral;

(c)

history of mental health treatment, including review of the client's records;

(d)

important developmental incidents;

(e)

maltreatment, trauma, or abuse issues;

(f)

history of alcohol and drug usage and treatment;

(g)

health history and family health history, including physical, chemical, and mental health history; and

(h)

cultural influences and their impact on the client;

(3)

the client's mental status examination;

(4)

the assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;

(5)

the screenings used to determine the client's substance use, abuse, or dependency and other standardized screening instruments determined by the commissioner;

(6)

assessment methods and use of standardized assessment tools by the provider as determined and periodically updated by the commissioner;

(7)

the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and

(8)

the client data that is adequate to support the findings on all axes of the current edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association; and any differential diagnosis.

C.

An extended diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The face-to-face interview is conducted over three or more assessment appointments because the client's complex needs necessitate significant additional assessment time. Complex needs are those caused by acuity of psychotic disorder; cognitive or neurocognitive impairment; need to consider past diagnoses and determine their current applicability; co-occurring substance abuse use disorder; or disruptive or changing environments, communication barriers, or cultural considerations as documented in the assessment. For child clients, the appointments may be conducted outside the diagnostician's office for face-to-face consultation and information gathering with family members, doctors, caregivers, teachers, and other providers, with or without the child present, and may involve directly observing the child in various settings that the child frequents such as home, school, or care settings. To complete the diagnostic assessment with adult clients, the appointments may be conducted outside of the diagnostician's office for face-to-face assessment with the adult client. The appointment may involve directly observing the adult client in various settings that the adult frequents, such as home, school, job, service settings, or community settings. The appointments may include face-to-face meetings with the adult client and the client's family members, doctors, caregivers, teachers, social support network members, recovery support resource representatives, and other providers for consultation and information gathering for the diagnostic assessment. The components of an extended diagnostic assessment include the following relevant information:

(1)

for children under age 5:

(a)

utilization of the DC:0-3R diagnostic system for young children;

(b)

an early childhood mental status exam that assesses the client's developmental, social, and emotional functioning and style both within the family and with the examiner and includes:

i.

physical appearance including dysmorphic features;

ii.

reaction to new setting and people and adaptation during evaluation;

iii.

self-regulation, including sensory regulation, unusual behaviors, activity level, attention span, and frustration tolerance;

iv.

physical aspects, including motor function, muscle tone, coordination, tics, abnormal movements, and seizure activity;

v.

vocalization and speech production, including expressive and receptive language;

vi.

thought, including fears, nightmares, dissociative states, and hallucinations;

vii.

affect and mood, including modes of expression, range, responsiveness, duration, and intensity;

viii.

play, including structure, content, symbolic functioning, and modulation of aggression;

ix.

cognitive functioning; and

x.

relatedness to parents, other caregivers, and examiner; and

(c)

other assessment tools as determined and periodically revised by the commissioner;

(2)

for children ages 5 to 18, completion of other assessment standards for children as determined and periodically revised by the commissioner; and

(3)

for adults, completion of other assessment standards for adults as determined and periodically revised by the commissioner.

D.

A brief diagnostic assessment must include a face-to-face interview with the client and a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The professional or practitioner must gather initial background information using the components of a standard diagnostic assessment in item B, subitems (1), (2), unit (b), (3), and (5), and draw a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's immediate needs or presenting problem. Treatment sessions conducted under authorization of a brief assessment may be used to gather additional information necessary to complete a standard diagnostic assessment or an extended diagnostic assessment.

E.

Adult diagnostic assessment update includes a face-to-face interview with the client, and contains a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C, who reviews a standard or extended diagnostic assessment. The adult diagnostic assessment update must update the most recent assessment document in writing in the following areas:

(1)

review of the client's life situation, including an interview with the client about the client's current life situation, and a written update of those parts where significant new or changed information exists, and documentation where there has not been significant change;

(2)

review of the client's presenting problems, including an interview with the client about current presenting problems and a written update of those parts where there is significant new or changed information, and note parts where there has not been significant change;

(3)

screenings for substance use, abuse, or dependency and other screenings as determined by the commissioner;

(4)

the client's mental health status examination;

(5)

assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;

(6)

the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary, or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and

(7)

the client's diagnosis on all axes of the current edition of the Diagnostic and Statistical Manual and any differential diagnosis.

Subp. 2.

Neuropsychological assessment.

A neuropsychological assessment must include a face-to-face interview with the client, the interpretation of the test results, and preparation and completion of a report. A client is eligible for a neuropsychological assessment if at least one of the following criteria is met:

A.

There is a known or strongly suspected brain disorder based on medical history or neurological evaluation such as a history of significant head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative disorders, significant exposure to neurotoxins, central nervous system infections, metabolic or toxic encephalopathy, fetal alcohol syndrome, or congenital malformations of the brain; or

B.

In the absence of a medically verified brain disorder based on medical history or neurological evaluation, there are cognitive or behavioral symptoms that suggest that the client has an organic condition that cannot be readily attributed to functional psychopathology, or suspected neuropsychological impairment in addition to functional psychopathology. Examples include:

(1)

poor memory or impaired problem solving;

(2)

change in mental status evidenced by lethargy, confusion, or disorientation;

(3)

deterioration in level of functioning;

(4)

marked behavioral or personality change;

(5)

in children or adolescents, significant delays in academic skill acquisition or poor attention relative to peers;

(6)

in children or adolescents, significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers; and

(7)

in children or adolescents, significant inability to develop expected knowledge, skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or physical demands.

C.

If neither criterion in item A nor B is fulfilled, neuropsychological evaluation is not indicated.

D.

The neuropsychological assessment must be conducted by a neuropsychologist with competence in the area of neuropsychological assessment as stated to the Minnesota Board of Psychology who:

(1)

was awarded a diploma by the American Board of Clinical Neuropsychology, the American Board of Professional Neuropsychology, or the American Board of Pediatric Neuropsychology;

(2)

earned a doctoral degree in psychology from an accredited university training program:

(a)

completed an internship, or its equivalent, in a clinically relevant area of professional psychology;

(b)

completed the equivalent of two full-time years of experience and specialized training, at least one which is at the postdoctoral level, in the study and practices of clinical neuropsychology and related neurosciences supervised by a clinical neuropsychologist; and

(c)

holds a current license to practice psychology independently in accordance with Minnesota Statutes, sections 148.88 to 148.98;

(3)

is licensed or credentialed by another state's board of psychology examiners in the specialty of neuropsychology using requirements equivalent to requirements specified by one of the boards named in subitem (1); or

(4)

was approved by the commissioner as an eligible provider of neuropsychological assessment prior to December 31, 2010.

Subp. 3.

Neuropsychological testing.

A.

Medical assistance covers neuropsychological testing when the client has either:

(1)

a significant mental status change that is not a result of a metabolic disorder that has failed to respond to treatment;

(2)

in children or adolescents, a significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers;

(3)

in children or adolescents, significant inability to develop expected knowledge, skills, or abilities, as required to adapt to new or changing cognitive, social, physical, or emotional demands; or

(4)

a significant behavioral change, memory loss, or suspected neuropsychological impairment in addition to functional psychopathology, or other organic brain injury or one of the following:

(a)

traumatic brain injury;

(b)

stroke;

(c)

brain tumor;

(d)

substance abuse or dependence;

(e)

cerebral anoxic or hypoxic episode;

(f)

central nervous system infection or other infectious disease;

(g)

neoplasms or vascular injury of the central nervous system;

(h)

neurodegenerative disorders;

(i)

demyelinating disease;

(j)

extrapyramidal disease;

(k)

exposure to systemic or intrathecal agents or cranial radiation known to be associated with cerebral dysfunction;

(l)

systemic medical conditions known to be associated with cerebral dysfunction, including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and related hematologic anomalies, and autoimmune disorders such as lupus, erythematosis, or celiac disease;

(m)

congenital genetic or metabolic disorders known to be associated with cerebral dysfunction, such as phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;

(n)

severe or prolonged nutrition or malabsorption syndromes; or

(o)

a condition presenting in a manner making it difficult for a clinician to distinguish between:

i.

the neurocognitive effects of a neurogenic syndrome such as dementia or encephalopathy; and

ii.

a major depressive disorder when adequate treatment for major depressive disorder has not resulted in improvement in neurocognitive function, or another disorder such as autism, selective mutism, anxiety disorder, or reactive attachment disorder.

B.

Neuropsychological testing must be administered or clinically supervised by a neuropsychologist qualified as defined in subpart 2, item D.

C.

Neuropsychological testing is not covered when performed:

(1)

primarily for educational purposes;

(2)

primarily for vocational counseling or training;

(3)

for personnel or employment testing;

(4)

as a routine battery of psychological tests given at inpatient admission or continued stay; or

(5)

for legal or forensic purposes.

Subp. 4.

Psychological testing.

Psychological testing must meet the following requirements:

A.

The psychological testing must:

(1)

be administered or clinically supervised by a licensed psychologist with competence in the area of psychological testing as stated to the Minnesota Board of Psychology; and

(2)

be validated in a face-to-face interview between the client and a licensed psychologist or a mental health practitioner working as a clinical psychology trainee as required by part 9505.0371, subpart 5, item C, under the clinical supervision of a licensed psychologist according to part 9505.0371, subpart 5, item A, subitem (2).

B.

The administration, scoring, and interpretation of the psychological tests must be done under the clinical supervision of a licensed psychologist when performed by a technician, psychometrist, or psychological assistant or as part of a computer-assisted psychological testing program.

C.

The report resulting from the psychological testing must be:

(1)

signed by the psychologist conducting the face-to-face interview;

(2)

placed in the client's record; and

(3)

released to each person authorized by the client.

Subp. 5.

Explanations of findings.

To be eligible for medical assistance payment, the mental health professional providing the explanation of findings must obtain the authorization of the client or the client's representative to release the information as required in part 9505.0371, subpart 6. Explanation of findings is provided to the client, client's family, and caregivers, or to other providers to help them understand the results of the testing or diagnostic assessment, better understand the client's illness, and provide professional insight needed to carry out a plan of treatment. An explanation of findings is not paid separately when the results of psychological testing or a diagnostic assessment are explained to the client or the client's representative as part of the psychological testing or a diagnostic assessment.

Subp. 6.

Psychotherapy.

Medical assistance covers psychotherapy as conducted by a mental health professional or a mental health practitioner as defined in part 9505.0371, subpart 5, item C, as provided in this subpart.

A.

Individual psychotherapy is psychotherapy designed for one client.

B.

Family psychotherapy is designed for the client and one or more family members or the client's primary caregiver whose participation is necessary to accomplish the client's treatment goals. Family members or primary caregivers participating in a therapy session do not need to be eligible for medical assistance. For purposes of this subpart, the phrase "whose participation is necessary to accomplish the client's treatment goals" does not include shift or facility staff members at the client's residence. Medical assistance payment for family psychotherapy is limited to face-to-face sessions at which the client is present throughout the family psychotherapy session unless the mental health professional believes the client's absence from the family psychotherapy session is necessary to carry out the client's individual treatment plan. If the client is excluded, the mental health professional must document the reason for and the length of time of the exclusion. The mental health professional must also document the reason or reasons why a member of the client's family is excluded.

C.

Group psychotherapy is appropriate for individuals who because of the nature of their emotional, behavioral, or social dysfunctions can derive mutual benefit from treatment in a group setting. For a group of three to eight persons, one mental health professional or practitioner is required to conduct the group. For a group of nine to 12 persons, a team of at least two mental health professionals or two mental health practitioners or one mental health professional and one mental health practitioner is required to co-conduct the group. Medical assistance payment is limited to a group of no more than 12 persons.

D.

A multiple-family group psychotherapy session is eligible for medical assistance payment if the psychotherapy session is designed for at least two but not more than five families. Multiple-family group psychotherapy is clearly directed toward meeting the identified treatment needs of each client as indicated in client's treatment plan. If the client is excluded, the mental health professional or practitioner must document the reason for and the length of the time of the exclusion. The mental health professional or practitioner must document the reasons why a member of the client's family is excluded.

Subp. 7.

Medication management.

The determination or evaluation of the effectiveness of a client's prescribed drug must be carried out by a physician or by an advanced practice registered nurse, as defined in Minnesota Statutes, sections 148.171 to 148.285, who is qualified in psychiatric nursing.

Subp. 8.

Adult day treatment.

Adult day treatment payment limitations include the following conditions.

A.

Adult day treatment must consist of at least one hour of group psychotherapy, and must include group time focused on rehabilitative interventions, or other therapeutic services that are provided by a multidisciplinary staff. Adult day treatment is an intensive psychotherapeutic treatment. The services must stabilize the client's mental health status, and develop and improve the client's independent living and socialization skills. The goal of adult day treatment is to reduce or relieve the effects of mental illness so that an individual is able to benefit from a lower level of care and to enable the client to live and function more independently in the community. Day treatment services are not a part of inpatient or residential treatment services.

B.

To be eligible for medical assistance payment, a day treatment program must:

(1)

be reviewed by and approved by the commissioner;

(2)

be provided to a group of clients by a multidisciplinary staff under the clinical supervision of a mental health professional;

(3)

be available to the client at least two days a week for at least three consecutive hours per day. The day treatment may be longer than three hours per day, but medical assistance must not reimburse a provider for more than 15 hours per week;

(4)

include group psychotherapy done by a mental health professional, or mental health practitioner qualified according to part 9505.0371, subpart 5, item C, and rehabilitative interventions done by a mental health professional or mental health practitioner daily;

(5)

be included in the client's individual treatment plan as necessary and appropriate. The individual treatment plan must include attainable, measurable goals as they relate to services and must be completed before the first day treatment session. The vendor must review the recipient's progress and update the treatment plan at least every 30 days until the client is discharged and include an available discharge plan for the client in the treatment plan; and

(6)

document the interventions provided and the client's response daily.

C.

To be eligible for adult day treatment, a recipient must:

(1)

be 18 years of age or older;

(2)

not be residing in a nursing facility, hospital, institute of mental disease, or regional treatment center, unless the recipient has an active discharge plan that indicates a move to an independent living arrangement within 180 days;

(3)

have a diagnosis of mental illness as determined by a diagnostic assessment;

(4)

have the capacity to engage in the rehabilitative nature, the structured setting, and the therapeutic parts of psychotherapy and skills activities of a day treatment program and demonstrate measurable improvements in the recipient's functioning related to the recipient's mental illness that would result from participating in the day treatment program;

(5)

have at least three areas of functional impairment as determined by a functional assessment with the domains prescribed by Minnesota Statutes, section 245.462, subdivision 11a;

(6)

have a level of care determination that supports the need for the level of intensity and duration of a day treatment program; and

(7)

be determined to need day treatment by a mental health professional who must deem the day treatment services medically necessary.

D.

The following services are not covered by medical assistance if they are provided by a day treatment program:

(1)

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, craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours;

(2)

a social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's mental illness;

(3)

consultation with other providers or service agency staff about the care or progress of a client;

(4)

prevention or education programs provided to the community;

(5)

day treatment for recipients with primary diagnoses of alcohol or other drug abuse;

(6)

day treatment provided in the client's home;

(7)

psychotherapy for more than two hours daily; and

(8)

participation in meal preparation and eating that is not part of a clinical treatment plan to address the client's eating disorder.

Subp. 9.

Partial hospitalization.

Partial hospitalization is a covered service when it is an appropriate alternative to inpatient hospitalization for a client who is experiencing an acute episode of mental illness that meets the criteria for an inpatient hospital admission as specified in part 9505.0520, subpart 1, and who has the family and community resources necessary and appropriate to support the client's residence in the community. Partial hospitalization consists of multiple intensive short-term therapeutic services provided by a multidisciplinary staff to treat the client's mental illness.

Subp. 10.

Dialectical behavior therapy (DBT).

Dialectical behavior therapy (DBT) treatment services must meet the following criteria:

A.

DBT must be provided according to this subpart and Minnesota Statutes, section 256B.0625, subdivision 5l.

B.

DBT is an outpatient service that is determined to be medically necessary by either: (1) a mental health professional qualified according to part 9505.0371, subpart 5, or (2) a mental health practitioner working as a clinical trainee according to part 9505.0371, subpart 5, item C, who is under the clinical supervision of a mental health professional according to part 9505.0371, subpart 5, item D, with specialized skill in dialectical behavior therapy. The treatment recommendation must be based upon a comprehensive evaluation that includes a diagnostic assessment and functional assessment of the client, and review of the client's prior treatment history. Treatment services must be provided pursuant to the client's individual treatment plan and provided to a client who satisfies the criteria in item C.

C.

To be eligible for DBT, a client must:

(1)

be 18 years of age or older;

(2)

have mental health needs that cannot be met with other available community-based services or that must be provided concurrently with other community-based services;

(3)

meet one of the following criteria:

(a)

have a diagnosis of borderline personality disorder; or

(b)

have multiple mental health diagnoses and exhibit behaviors characterized by impulsivity, intentional self-harm behavior, and be at significant risk of death, morbidity, disability, or severe dysfunction across multiple life areas;

(4)

understand and be cognitively capable of participating in DBT as an intensive therapy program and be able and willing to follow program policies and rules assuring safety of self and others; and

(5)

be at significant risk of one or more of the following if DBT is not provided:

(a)

mental health crisis;

(b)

requiring a more restrictive setting such as hospitalization;

(c)

decompensation; or

(d)

engaging in intentional self-harm behavior.

D.

The treatment components of DBT are individual therapy and group skills as follows:

(1)

Individual DBT combines individualized rehabilitative and psychotherapeutic interventions to treat suicidal and other dysfunctional behaviors and reinforce the use of adaptive skillful behaviors. The therapist must:

(a)

identify, prioritize, and sequence behavioral targets;

(b)

treat behavioral targets;

(c)

generalize DBT skills to the client's natural environment through telephone coaching outside of the treatment session;

(d)

measure the client's progress toward DBT targets;

(e)

help the client manage crisis and life-threatening behaviors; and

(f)

help the client learn and apply effective behaviors when working with other treatment providers.

(2)

Individual DBT therapy is provided by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.

(3)

Group DBT skills training combines individualized psychotherapeutic and psychiatric rehabilitative interventions conducted in a group format to reduce the client's suicidal and other dysfunctional coping behaviors and restore function by teaching the client adaptive skills in the following areas:

(a)

mindfulness;

(b)

interpersonal effectiveness;

(c)

emotional regulation; and

(d)

distress tolerance.

(4)

Group DBT skills training is provided by two mental health professionals, or by a mental health professional cofacilitating with a mental health practitioner.

(5)

The need for individual DBT skills training must be determined by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.

E.

A program must be certified by the commissioner as a DBT provider. To qualify for certification, a provider must:

(1)

hold current accreditation as a DBT program from a nationally recognized certification body approved by the commissioner or submit to the commissioner's inspection and provide evidence that the DBT program's policies, procedures, and practices will continuously meet the requirements of this subpart;

(2)

be enrolled as a MHCP provider;

(3)

collect and report client outcomes as specified by the commissioner; and

(4)

have a manual that outlines the DBT program's policies, procedures, and practices which meet the requirements of this subpart.

F.

The DBT treatment team must consist of persons who are trained in DBT treatment. The DBT treatment team may include persons from more than one agency. Professional and clinical affiliations with the DBT team must be delineated:

(1)

A DBT team leader must:

(a)

be a mental health professional employed by, affiliated with, or contracted by a DBT program certified by the commissioner;

(b)

have appropriate competencies and working knowledge of the DBT principles and practices; and

(c)

have knowledge of and ability to apply the principles and DBT practices that are consistent with evidence-based practices.

(2)

DBT team members who provide individual DBT or group skills training must:

(a)

be a mental health professional or be a mental health practitioner, who is employed by, affiliated with, or contracted with a DBT program certified by the commissioner;

(b)

have or obtain appropriate competencies and working knowledge of DBT principles and practices within the first six months of becoming a part of the DBT program;

(c)

have or obtain knowledge of and ability to apply the principles and practices of DBT consistently with evidence-based practices within the first six months of working at the DBT program;

(d)

participate in DBT consultation team meetings; and

(e)

require mental health practitioners to have ongoing clinical supervision by a mental health professional who has appropriate competencies and working knowledge of DBT principles and practices.

Subp. 11.

Noncovered services.

The mental health services in items A to J are not eligible for medical assistance payment under this part:

A.

a mental health service that is not medically necessary;

B.

a neuropsychological assessment carried out by a person other than a neuropsychologist who is qualified according to part 9505.0372, subpart 2, item D;

C.

a service ordered by a court that is solely for legal purposes and not related to the recipient's diagnosis or treatment for mental illness;

D.

services dealing with external, social, or environmental factors that do not directly address the recipient's physical or mental health;

E.

a service that is only for a vocational purpose or an educational purpose that is not mental health related;

F.

staff training that is not related to a client's individual treatment plan or plan of care;

G.

child and adult protection services;

H.

fund-raising activities;

I.

community planning; and

J.

client transportation.

9520.0010 STATUTORY AUTHORITY AND PURPOSE.

Parts 9520.0010 to 9520.0230 provide methods and procedures relating to the establishment and operation of area-wide, comprehensive, community-based mental health, developmental disability, and chemical dependency programs under state grant-in-aid as provided under Minnesota Statutes, sections 245.61 to 245.69. Minnesota Statutes, sections 245.61 to 245.69 are entitled The Community Mental Health Services Act. For purposes of these parts, "community mental health services" includes services to persons who have mental or emotional disorders or other psychiatric disabilities, developmental disabilities, and chemical dependency, including drug abuse and alcoholism.

9520.0020 BOARD DUTIES.

The community mental health board has the responsibility for ensuring the planning, development, implementation, coordination, and evaluation of the community comprehensive mental health program for the mentally ill/behaviorally disabled, developmentally disabled, and chemically dependent populations in the geographic area it serves. It also has the responsibility for ensuring delivery of services designated by statute.

9520.0030 DEFINITIONS.

Parts 9520.0040 and 9520.0050 also set forth definitions of community mental health centers and community mental health clinics.

9520.0040 COMMUNITY MENTAL HEALTH CENTER.

A community mental health center means an agency which includes all of the following:

A.

Established under the provision of Minnesota Statutes, sections 245.61 to 245.69.

B.

Provides as a minimum the following services for individuals with mental or emotional disorders, developmental disabilities, alcoholism, drug abuse, and other psychiatric conditions. The extent of each service to be provided by the center shall be indicated in the program plan, which is to reflect the problems, needs, and resources of the community served:

(1)

collaborative and cooperative services with public health and other groups for programs of prevention of mental illness, developmental disability, alcoholism, drug abuse, and other psychiatric disorders;

(2)

informational and educational services to schools, courts, health and welfare agencies, both public and private;

(3)

informational and educational services to the general public, lay, and professional groups;

(4)

consultative services to schools, courts, and health and welfare agencies, both public and private;

(5)

outpatient diagnostic and treatment services; and

(6)

rehabilitative services, particularly for those who have received prior treatment in an inpatient facility.

C.

Provides or contracts for detoxification, evaluation, and referral for chemical dependency services (Minnesota Statutes, section 254A.08).

D.

Provides specific coordination for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. (Minnesota Statutes, sections 254A.07 and 245.61).

E.

Has a competent multidisciplinary mental health/developmental disability/chemical dependency professional team whose members meet the professional standards in their respective fields.

F.

The professional mental health team is qualified by specific mental health training and experience and shall include as a minimum the services of each of the following:

(1)

a licensed physician, who has completed an approved residency program in psychiatry; and

(2)

a doctoral clinical, counseling, or health care psychologist, who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:

(3)

a clinical social worker with a master's degree in social work from an accredited college or university; and/or

(4)

a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health nursing with mental health major, maternal and child health with mental health major, etc.

G.

The multidisciplinary staff shall be sufficient in number to implement and operate the described program of the center. In addition to the above, this team should include other professionals, paraprofessionals, and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner. If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the center, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and show evidence of how the specialized functions of the required professionals are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.

9520.0050 COMMUNITY MENTAL HEALTH CLINIC.

Subpart 1.

Definitions.

A community mental health clinic is an agency which devotes, as its major service, at least two-thirds of its resources for outpatient mental health diagnosis, treatment, and consultation by a multidisciplinary professional mental health team. The multidisciplinary professional mental health team is qualified by special mental health training and experience and shall include as a minimum the services of each of the following:

A.

a licensed physician, who has completed an approved residency program in psychiatry; and

B.

a doctoral clinical, or counseling or health care psychologist who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:

C.

a clinical social worker with a master's degree in social work from an accredited college or university; and/or

D.

a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health with a mental health major, maternal and child health with a mental health major.

Subp. 2.

Other members of multidisciplinary team.

The multidisciplinary team shall be sufficient in number to implement and operate the described program of the clinic. In addition to the above, this team should include other professionals, paraprofessionals and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner.

Subp. 3.

Efforts to acquire staff.

If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the clinic, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and evidence of how the specialized functions of the required professional positions are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.

9520.0060 ANNUAL PLAN AND BUDGET.

On or before the date designated by the commissioner, each year the chair of the community mental health board or director of the community mental health program, provided for in Minnesota Statutes, section 245.62, shall submit an annual plan identifying program priorities in accordance with state grant-in-aid guidelines, and a budget on prescribed report forms for the next state fiscal year, together with the recommendations of the community mental health board, to the commissioner of human services for approval as provided under Minnesota Statutes, section 245.63.

9520.0070 FISCAL AFFILIATES.

Other providers of community mental health services may affiliate with the community mental health center and may be approved and eligible for state grant-in-aid funds. The state funding for other community mental health services shall be contingent upon appropriate inclusion in the center's community mental health plan for the continuum of community mental health services and conformity with the state's appropriate disability plan for mental health, developmental disability, or chemical dependency. Fiscal affiliates (funded contracting agencies) providing specialized services under contract must meet all rules and standards that apply to the services they are providing.

9520.0080 OTHER REQUIRED REPORTS.

The program director of the community mental health program shall provide the commissioner of human services with such reports of program activities as the commissioner may require.

9520.0090 FUNDING.

All state community mental health funding shall go directly to the community mental health board or to a human service board established pursuant to Laws of Minnesota 1975, chapter 402, which itself provides or contracts with another agency to provide the community mental health program. Such programs must meet the standards and rules for community mental health programs as enunciated in parts 9520.0010 to 9520.0230 in accordance with Laws of Minnesota 1975, chapter 402.

9520.0100 OPERATION OF OTHER PROGRAMS.

When the governing authority of the community mental health program operates other programs, services, or activities, only the community mental health center program shall be subject to these parts.

9520.0110 APPLICATIONS AND AGREEMENTS BY LOCAL COUNTIES.

New applications for state assistance or applications for renewal of support must be accompanied by an agreement executed by designated signatories on behalf of the participating counties that specifies the involved counties, the amount and source of local funds in each case, and the period of support. The local funds to be used to match state grant-in-aid must be assured in writing on Department of Human Services forms by the local funding authority(ies).

9520.0120 USE OF MATCHING FUNDS.

Funds utilized by the director as authorized by the community mental health board to match a state grant-in-aid must be available to that director for expenditures for the same general purpose as the state grant-in-aid funds.

9520.0130 QUARTERLY REPORTS.

The director of the community mental health program shall, within 20 days after the end of the quarter, submit quarterly prescribed reports to the commissioner of human services (controller's office), containing all receipts, expenditures, and cash balance, subject to an annual audit by the commissioner or his/her designee.

9520.0140 PAYMENTS.

Payments on approved grants will be made subsequent to the department's receipt of the program's quarterly reporting forms, unless the commissioner of human services has determined that funds allocated to a program are not needed for that program. Payments shall be in an amount of at least equal to the quarterly allocation minus any unexpended balance from the previous quarter providing this payment does not exceed the program grant award. In the event the program does not report within the prescribed time, the department will withhold the process of the program's payment until the next quarterly cycle.

9520.0150 FEES.

No fees shall be charged until the director with approval of the community mental health board has established fee schedules for the services rendered and they have been submitted to the commissioner of human services at least two months prior to the effective date thereof and have been approved by him/her. All fees shall conform to the approved schedules, which are accessible to the public.

9520.0160 SUPPLEMENTAL AWARDS.

The commissioner of human services may make supplemental awards to the community mental health boards.

9520.0170 WITHDRAWAL OF FUNDS.

The commissioner of human services may withdraw funds from any program that is not administered in accordance with its approved plan and budget. Written notice of such intended action will be provided to the director and community mental health board. Opportunity for hearing before the commissioner or his/her designee shall be provided.

9520.0180 BUDGET TRANSFERS.

Community mental health boards may make budget transfers within specified limits during any fiscal year without prior approval of the department. The specified limit which can be transferred in any fiscal year between program activity budgets shall be up to ten percent or up to $5,000 whichever is less. Transfers within an activity can be made into or out of line items with a specified limit of up to ten percent or up to $5,000 whichever is less. No line item can be increased or decreased by more than $5,000 or ten percent in a fiscal year without prior approval of the commissioner. Transfers above the specified limits can be made with prior approval from the commissioner. All transfers within and into program budget activities and/or line items must have prior approval by the community mental health board and this approval must be reflected in the minutes of its meeting, it must be reported to the commissioner with the reasons therefor, including a statement of how the transfer will affect program objectives.

9520.0190 BUDGET ADJUSTMENTS.

Budget adjustments made necessary by funding limitations shall be made by the commissioner and provided in writing to the director and board of the community mental health center.

9520.0200 CENTER DIRECTOR.

Every community mental health board receiving state funds for a community mental health program shall have a center director, who is the full-time qualified professional staff member who serves as the executive officer. To be considered qualified, the individual must have professional training to at least the level of graduate degree in his/her clinical and/or administrative discipline, which is relevant to MH-DD-CD and a minimum of two years experience in community mental health programs. The center director is responsible for the planning/design, development, coordination, and evaluation of a comprehensive, area-wide program and for the overall administration of services operated by the board.

The center director shall be appointed by the community mental health board and shall be approved by the commissioner of human services.

9520.0210 DEADLINE FOR APPROVAL OR DENIAL OF REQUEST FOR APPROVAL STATUS.

The commissioner shall approve or deny, in whole or in part, an application for state financial assistance within 90 days of receipt of the grant-in-aid application or by the beginning of the state fiscal year, whichever is the later.

9520.0230 ADVISORY COMMITTEE.

Subpart 1.

Purpose.

To assist the community mental health board in meeting its responsibilities as described in Minnesota Statutes, section 245.68 and to provide opportunity for broad community representation necessary for effective comprehensive mental health, developmental disability, and chemical dependency program planning, each community mental health board shall appoint a separate advisory committee in at least the three disability areas of mental health, developmental disability, and chemical dependency.

Subp. 2.

Membership.

The advisory committees shall consist of residents of the geographic area served who are interested and knowledgeable in the area governed by such committee.

Subp. 3.

Nominations for membership.

Nominations for appointments as members of the advisory committees are to be made to the community mental health board from agencies, organizations, groups, and individuals within the area served by the community mental health center. Appointments to the advisory committees are made by the community mental health board.

Subp. 4.

Board member on committee.

One community mental health board member shall serve on each advisory committee.

Subp. 5.

Nonprovider members.

Each advisory committee shall have at least one-half of its membership composed of individuals who are not providers of services to the three disability groups.

Subp. 6.

Representative membership.

Membership of each advisory committee shall generally reflect the population distribution of the service delivery area of the community mental health center.

Subp. 7.

Chairperson appointed.

The community mental health board shall appoint a chairperson for each advisory committee. The chairperson shall not be a community mental health board member nor a staff member. The power to appoint the chairperson may be delegated by the community mental health board to the individual advisory committee.

Subp. 8.

Committee responsibility to board.

Each advisory committee shall be directly responsible to the community mental health board. Direct communication shall be effected and maintained through contact between the chairperson of the particular advisory committee, or his/her designee, and the chairperson of the community mental health board, or his/her designee.

Subp. 9.

Staff.

Staff shall be assigned by the director to serve the staffing needs of each advisory committee.

Subp. 10.

Study groups and task forces.

Each advisory committee may appoint study groups and task forces upon consultation with the community mental health board. It is strongly recommended that specific attention be given to the aging and children and youth populations.

Subp. 11.

Quarterly meetings required.

Each advisory committee shall meet at least quarterly.

Subp. 12.

Annual report required.

Each advisory committee must make a formal written and oral report on its work to the community mental health board at least annually.

Subp. 13.

Minutes.

Each advisory committee shall submit copies of minutes of their meetings to the community mental health board and to the Department of Human Services (respective disability group program divisions).

Subp. 14.

Duties of advisory committee.

The advisory committees shall be charged by the community mental health board with assisting in the identification of the community's needs for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. The advisory committee also assists the community mental health board in determining priorities for the community programs. Based on the priorities, each advisory committee shall recommend to the community mental health board ways in which the limited available community resources (work force, facilities, and finances) can be put to maximum and optimal use.

Subp. 15.

Recommendations.

The advisory committee recommendations made to the community mental health board shall be included as a separate section in the grant-in-aid request submitted to the Department of Human Services by the community mental health board.

Subp. 16.

Assessment of programs.

The advisory committees shall assist the community mental health board in assessing the programs carried on by the community mental health board, and make recommendations regarding the reordering of priorities and modifying of programs where necessary.

9520.0750 PURPOSE.

Parts 9520.0750 to 9520.0870 establish standards for approval of mental health centers and mental health clinics for purposes of insurance and subscriber contract reimbursement under Minnesota Statutes, section 62A.152.

9520.0760 DEFINITIONS.

Subpart 1.

Scope.

As used in parts 9520.0760 to 9520.0870, the following terms have the meanings given them.

Subp. 2.

Application.

"Application" means the formal statement by a center to the commissioner, on the forms created for this purpose, requesting recognition as meeting the requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.

Subp. 3.

Approval.

"Approval" means the determination by the commissioner that the applicant center has met the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, and is therefore eligible to claim reimbursement for outpatient clinical services under the terms of Minnesota Statutes, section 62A.152. Approval of a center under these parts does not mean approval of a multidisciplinary staff person of such center to claim reimbursement from medical assistance or other third-party payors when practicing privately. Approval of a center under these parts does not mean approval of such center to claim reimbursement from medical assistance.

Subp. 4.

Case review.

"Case review" means a consultation process thoroughly examining a client's condition and treatment. It includes review of the client's reason for seeking treatment, diagnosis and assessment, and the individual treatment plan; review of the appropriateness, duration, and outcome of treatment provided; and treatment recommendations.

Subp. 5.

Center.

"Center" means a public or private health and human services facility which provides clinical services in the treatment of mental illness. It is an abbreviated term used in place of "mental health center" or "mental health clinic" throughout parts 9520.0750 to 9520.0870.

Subp. 6.

Client.

"Client" means a person accepted by the center to receive clinical services in the diagnosis and treatment of mental illness.

Subp. 7.

Clinical services.

"Clinical services" means services provided to a client to diagnose, describe, predict, and explain that client's status relative to a disabling condition or problem, and where necessary, to treat the client to reduce impairment due to that condition. Clinical services also include individual treatment planning, case review, record keeping required for treatment, peer review, and supervision.

Subp. 8.

Commissioner.

"Commissioner" means the commissioner of the Minnesota Department of Human Services or a designated representative.

Subp. 9.

Competent.

"Competent" means having sufficient knowledge of and proficiency in a specific mental illness assessment or treatment service, technique, method, or procedure, documented by experience, education, training, and certification, to be able to provide it to a client with little or no supervision.

Subp. 10.

Consultation.

"Consultation" means the process of deliberating or conferring between multidisciplinary staff regarding a client and the client's treatment.

Subp. 11.

Deferral.

"Deferral" means the determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 and is not approved, but is granted a period of time to comply with these standards and receive a second review without reapplication.

Subp. 12.

Department.

"Department" means the Minnesota Department of Human Services.

Subp. 13.

Disapproval or withdrawal of approval.

"Disapproval" or "withdrawal of approval" means a determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.

Subp. 14.

Discipline.

"Discipline" means a branch of professional knowledge or skill acquired through a specific course of study and training and usually documented by a specific educational degree or certification of proficiency. Examples of the mental health disciplines include but are not limited to psychiatry, psychology, clinical social work, and psychiatric nursing.

Subp. 15.

Documentation.

"Documentation" means the automatically or manually produced and maintained evidence that can be read by person or machine, and that will attest to the compliance with requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.

Subp. 16.

Individual treatment plan.

"Individual treatment plan" means a written plan of intervention and treatment developed on the basis of assessment results for a specific client, and updated as necessary. The plan specifies the goals and objectives in measurable terms, states the treatment strategy, and identifies responsibilities of multidisciplinary staff.

Subp. 17.

Mental health practitioner.

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

A.

by having a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university and 2,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;

B.

by having 6,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;

C.

by being a graduate student in one of the behavioral sciences or related fields formally assigned to the center for clinical training by an accredited college or university; or

D.

by having a master's or other graduate degree in one of the behavioral sciences or related fields from an accredited college or university.

Documentation of compliance with part 9520.0800, subpart 4, item B is required for designation of work as supervised experience in the delivery of clinical services. Documentation of the accreditation of a college or university shall be a listing in Accredited Institutions of Postsecondary Education Programs, Candidates for the year the degree was issued. The master's degree in behavioral sciences or related fields shall include a minimum of 28 semester hours of graduate course credit in mental health theory and supervised clinical training, as documented by an official transcript.

Subp. 18.

Mental health professional.

"Mental health professional" has the meaning given in Minnesota Statutes, section 245.462, subdivision 18.

Subp. 19.

Mental illness.

"Mental illness" means a condition which results in an inability to interpret the environment realistically and in impaired functioning in primary aspects of daily living such as personal relations, living arrangements, work, and recreation, and which is listed in the clinical manual of the International Classification of Diseases (ICD-9-CM), Ninth Revision (1980), code range 290.0-302.99 or 306.0-316, or the corresponding code in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), Third Edition (1980), Axes I, II or III. These publications are available from the State Law Library.

Subp. 20.

Multidisciplinary staff.

"Multidisciplinary staff" means the mental health professionals and mental health practitioners employed by or under contract to the center to provide outpatient clinical services in the treatment of mental illness.

Subp. 21.

Serious violations of policies and procedures.

"Serious violations of policies and procedures" means a violation which threatens the health, safety, or rights of clients or center staff; the repeated nonadherence to center policies and procedures; and the nonadherence to center policies and procedures which result in noncompliance with Minnesota Statutes, section 245.69, subdivision 2 and parts 9520.0760 to 9520.0870.

Subp. 22.

Treatment strategy.

"Treatment strategy" means the particular form of service delivery or intervention which specifically addresses the client's characteristics and mental illness, and describes the process for achievement of individual treatment plan goals.

9520.0770 ORGANIZATIONAL STRUCTURE OF CENTER.

Subpart 1.

Basic unit.

The center or the facility of which it is a unit shall be legally constituted as a partnership, corporation, or government agency. The center shall be either the entire facility or a clearly identified unit within the facility which is administratively and clinically separate from the rest of the facility. All business shall be conducted in the name of the center or facility, except medical assistance billing by individually enrolled providers when the center is not enrolled.

Subp. 2.

Purpose, services.

The center shall document that the prevention, diagnosis, and treatment of mental illness are the main purposes of the center. If the center is a unit within a facility, the rest of the facility shall not provide clinical services in the outpatient treatment of mental illness. The facility may provide services other than clinical services in the treatment of mental illness, including medical services, chemical dependency services, social services, training, and education. The provision of these additional services is not reviewed in granting approval to the center under parts 9520.0760 to 9520.0870.

Subp. 3.

Governing body.

The center shall have a governing body. The governing body shall provide written documentation of its source of authority. The governing body shall be legally responsible for the implementation of the standards set forth in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 through the establishment of written policy and procedures.

Subp. 4.

Chart or statement of organization.

The center shall have an organizational chart or statement which specifies the relationships among the governing body, any administrative and support staff, mental health professional staff, and mental health practitioner staff; their respective areas of responsibility; the lines of authority involved; the formal liaison between administrative and clinical staff; and the relationship of the center to the rest of the facility and any additional services provided.

9520.0780 SECONDARY LOCATIONS.

Subpart 1.

Main and satellite offices.

The center shall notify the commissioner of all center locations. If there is more than one center location, the center shall designate one as the main office and all secondary locations as satellite offices. The main office as a unit and the center as a whole shall be in compliance with part 9520.0810. The main office shall function as the center records and documentation storage area and house most administrative functions for the center. Each satellite office shall:

A.

be included as a part of the legally constituted entity;

B.

adhere to the same clinical and administrative policies and procedures as the main office;

C.

operate under the authority of the center's governing body;

D.

store all center records and the client records of terminated clients at the main office;

E.

ensure that a mental health professional is at the satellite office and competent to supervise and intervene in the clinical services provided there, whenever the satellite office is open;

F.

ensure that its multidisciplinary staff have access to and interact with main center staff for consultation, supervision, and peer review; and

G.

ensure that clients have access to all clinical services provided in the treatment of mental illness and the multidisciplinary staff of the center.

Subp. 2.

Noncompliance.

If the commissioner determines that a secondary location is not in compliance with subpart 1, it is not a satellite office. Outpatient clinical services in the treatment of mental illness delivered by the center or facility of which it is a unit shall cease at that location, or the application shall be disapproved.

9520.0790 MINIMUM TREATMENT STANDARDS.

Subpart 1.

Multidisciplinary approach.

The center shall document that services are provided in a multidisciplinary manner. That documentation shall include evidence that staff interact in providing clinical services, that the services provided to a client involve all needed disciplines represented on the center staff, and that staff participate in case review and consultation procedures as described in subpart 6.

Subp. 2.

Intake and case assignment.

The center shall establish an intake or admission procedure which outlines the intake process, including the determination of the appropriateness of accepting a person as a client by reviewing the client's condition and need for treatment, the clinical services offered by the center, and other available resources. The center shall document that case assignment for assessment, diagnosis, and treatment is made to a multidisciplinary staff person who is competent in the service, in the recommended treatment strategy and in treating the individual client characteristics. Responsibility for each case shall remain with a mental health professional.

Subp. 3.

Assessment and diagnostic process.

The center shall establish an assessment and diagnostic process that determines the client's condition and need for clinical services. The assessment of each client shall include clinical consideration of the client's general physical, medical, developmental, family, social, psychiatric, and psychological history and current condition. The diagnostic statement shall include the diagnosis based on the codes in the International Classification of Diseases or the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and refer to the pertinent assessment data. The diagnosis shall be by or under the supervision of and signed by a psychiatrist or licensed psychologist. The diagnostic assessment, as defined by Minnesota Statutes, sections 245.462, subdivision 9, for adults, and 245.4871, subdivision 11, for children, must be provided by a licensed mental health professional in accordance with Minnesota Statutes, section 245.467, subdivision 2.

Subp. 4.

Treatment planning.

The individual treatment plan, based upon a diagnostic assessment of mental illness, shall be jointly developed by the client and the mental health professional. This planning procedure shall ensure that the client has been informed in the following areas: assessment of the client condition; treatment alternatives; possible outcomes and side effects of treatment; treatment recommendations; approximate length, cost, and hoped-for outcome of treatment; the client's rights and responsibilities in implementation of the individual treatment plan; staff rights and responsibilities in the treatment process; the Government Data Practices Act; and procedures for reporting grievances and alleged violation of client rights. If the client is considering chemotherapy, hospitalization, or other medical treatment, the appropriate medical staff person shall inform the client of the treatment alternatives, the effects of the medical procedures, and possible side effects. Clinical services shall be appropriate to the condition, age, sex, socioeconomic, and ethnic background of the client, and provided in the least restrictive manner. Clinical services shall be provided according to the individual treatment plan and existing professional codes of ethics.

Subp. 5.

Client record.

The center shall maintain a client record for each client. The record must document the assessment process, the development and updating of the treatment plan, the treatment provided and observed client behaviors and response to treatment, and serve as data for the review and evaluation of the treatment provided to a client. The record shall include:

A.

a statement of the client's reason for seeking treatment;

B.

a record of the assessment process and assessment data;

C.

the initial diagnosis based upon the assessment data;

D.

the individual treatment plan;

E.

a record of all medication prescribed or administered by multidisciplinary staff;

F.

documentation of services received by the client, including consultation and progress notes;

G.

when necessary, the client's authorization to release private information, and client information obtained from outside sources;

H.

at the closing of the case, a statement of the reason for termination, current client condition, and the treatment outcome; and

I.

correspondence and other necessary information.

Subp. 6.

Consultation; case review.

The center shall establish standards for case review and encourage the ongoing consultation among multidisciplinary staff. The multidisciplinary staff shall attend staff meetings at least twice monthly for a minimum of four hours per month, or a minimum of two hours per month if the multidisciplinary staff person provides clinical services in the treatment of mental illness less than 15 hours per week. The purpose of these meetings shall be case review and consultation. Written minutes of the meeting shall be maintained at the center for at least three years after the meeting.

Subp. 7.

Referrals.

If the necessary treatment or the treatment desired by the client is not available at the center, the center shall facilitate appropriate referrals. The multidisciplinary staff person shall discuss with the client the reason for the referral, potential treatment resources, and what the process will involve. The staff person shall assist in the process to ensure continuity of the planned treatment.

Subp. 8.

Emergency service.

The center shall ensure that clinical services to treat mental illness are available to clients on an emergency basis.

Subp. 9.

Access to hospital.

The center shall document that it has access to hospital admission for psychiatric inpatient care, and shall provide that access when needed by a client. This requirement for access does not require direct hospital admission privileges on the part of qualified multidisciplinary staff.

9520.0800 MINIMUM QUALITY ASSURANCE STANDARDS.

Subpart 1.

Policies and procedures.

The center shall develop written policies and procedures and shall document the implementation of these policies and procedures for each treatment standard and each quality assurance standard in subparts 2 to 7. The policies shall be approved by the governing body. The procedures shall indicate what actions or accomplishments are to be performed, who is responsible for each action, and any documentation or required forms. Multidisciplinary staff shall have access to a copy of the policies and procedures at all times.

Subp. 2.

Peer review.

The center shall have a multidisciplinary peer review system to assess the manner in which multidisciplinary staff provide clinical services in the treatment of mental illness. Peer review shall include the examination of clinical services to determine if the treatment provided was effective, necessary, and sufficient and of client records to determine if the recorded information is necessary and sufficient. The system shall ensure review of a randomly selected sample of five percent or six cases, whichever is less, of the annual caseload of each mental health professional by other mental health professional staff. Peer review findings shall be discussed with staff involved in the case and followed up by any necessary corrective action. Peer review records shall be maintained at the center.

Subp. 3.

Internal utilization review.

The center shall have a system of internal utilization review to examine the quality and efficiency of resource usage and clinical service delivery. The center shall develop and carry out a review procedure consistent with its size and organization which includes collection or review of information, analysis or interpretation of information, and application of findings to center operations. The review procedure shall minimally include, within any three year period of time, review of the appropriateness of intake, the provision of certain patterns of services, and the duration of treatment. Criteria may be established for treatment length and the provision of services for certain client conditions. Utilization review records shall be maintained, with an annual report to the governing body for applicability of findings to center operations.

Subp. 4.

Staff supervision.

Staff supervision:

A.

The center shall have a clinical evaluation and supervision procedure which identifies each multidisciplinary staff person's areas of competence and documents that each multidisciplinary staff person receives the guidance and support needed to provide clinical services for the treatment of mental illness in the areas they are permitted to practice.

B.

A mental health professional shall be responsible for the supervision of the mental health practitioner, including approval of the individual treatment plan and bimonthly case review of every client receiving clinical services from the practitioner. This supervision shall include a minimum of one hour of face-to-face, client-specific supervisory contact for each 40 hours of clinical services in the treatment of mental illness provided by the practitioner.

Subp. 5.

Continuing education.

The center shall require that each multidisciplinary staff person attend a minimum of 36 clock hours every two years of academic or practical course work and training. This education shall augment job-related knowledge, understanding, and skills to update or enhance staff competencies in the delivery of clinical services to treat mental illness. Continued licensure as a mental health professional may be substituted for the continuing education requirement of this subpart.

Subp. 6.

Violations of standards.

The center shall have procedures for the reporting and investigating of alleged unethical, illegal, or grossly negligent acts, and of the serious violation of written policies and procedures. The center shall document that the reported behaviors have been reviewed and that responsible disciplinary or corrective action has been taken if the behavior was substantiated. The procedures shall address both client and staff reporting of complaints or grievances regarding center procedures, staff, and services. Clients and staff shall be informed they may file the complaint with the department if it was not resolved to mutual satisfaction. The center shall have procedures for the reporting of suspected abuse or neglect of clients, in accordance with Minnesota Statutes, sections 611A.32, subdivision 5; 626.556; and 626.557.

Subp. 7.

Data classification.

Client information compiled by the center, including client records and minutes of case review and consultation meetings, shall be protected as private data under the Minnesota Government Data Practices Act.

9520.0810 MINIMUM STAFFING STANDARDS.

Subpart 1.

Required staff.

Required staff:

A.

The multidisciplinary staff of a center shall consist of at least four mental health professionals. At least two of the mental health professionals shall each be employed or under contract for a minimum of 35 hours a week by the center. Those two mental health professionals shall be of different disciplines.

B.

The mental health professional staff shall include a psychiatrist and a licensed psychologist.

C.

The mental health professional employed or under contract to the center to meet the requirement of item B shall be at the main office of the center and providing clinical services in the treatment of mental illness at least eight hours every two weeks.

Subp. 2.

Additional staff; staffing balance.

Additional mental health professional staff may be employed by or under contract to the center provided that no single mental health discipline or combination of allied fields shall comprise more than 60 percent of the full-time equivalent mental health professional staff. This provision does not apply to a center with fewer than six full-time equivalent mental health professional staff. Mental health practitioners may also be employed by or under contract to a center to provide clinical services for the treatment of mental illness in their documented area of competence. Mental health practitioners shall not comprise more than 25 percent of the full-time equivalent multidisciplinary staff. In determination of full-time equivalence, only time spent in clinical services for the treatment of mental illness shall be considered.

Subp. 3.

Multidisciplinary staff records.

The center shall maintain records sufficient to document that the center has determined and verified the clinical service qualifications of each multidisciplinary staff person, and sufficient to document each multidisciplinary staff person's terms of employment.

Subp. 4.

Credentialed occupations.

The center shall adhere to the qualifications and standards specified by rule for any human service occupation credentialed under Minnesota Statutes, section 214.13 and employed by or under contract to the center.

9520.0820 APPLICATION PROCEDURES.

Subpart 1.

Form.

A facility seeking approval as a center for insurance reimbursement of its outpatient clinical services in treatment of mental illness must make formal application to the commissioner for such approval. The application form for this purpose may be obtained from the Mental Illness Program Division of the department. The application form shall require only information which is required by statute or rule, and shall require the applicant center to explain and provide documentation of compliance with the minimum standards in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.

Subp. 2.

Fee.

Each application shall be accompanied by payment of the nonrefundable application fee. The fee shall be established and adjusted in accordance with Minnesota Statutes, section 16A.128 to cover the costs to the department in implementing Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.

Subp. 3.

Completed application.

The application is considered complete on the date the application fee and all information required in the application form are received by the department.

Subp. 4.

Coordinator.

The center shall designate in the application a mental health professional as the coordinator for issues surrounding compliance with parts 9520.0760 to 9520.0870.

9520.0830 REVIEW OF APPLICANT CENTERS.

Subpart 1.

Site visit.

The formal review shall begin after the completed application has been received, and shall include an examination of the written application and a visit to the center. The applicant center shall be offered a choice of site visit dates, with at least one date falling within 60 days of the date on which the department receives the complete application. The site visit shall include interviews with multidisciplinary staff and examination of a random sample of client records, consultation minutes, quality assurance reports, and multidisciplinary staff records.

Subp. 2.

Documentation.

If implementation of a procedure is too recent to be reliably documented, a written statement of the planned implementation shall be accepted as documentation on the initial application. The evidence of licensure or accreditation through another regulating body shall be accepted as documentation of a specific procedure when the required minimum standard of that body is the same or higher than a specific provision of parts 9520.0760 to 9520.0870.

9520.0840 DECISION ON APPLICATION.

Subpart 1.

Written report.

Upon completion of the site visit, a report shall be written. The report shall include a statement of findings, a recommendation to approve, defer, or disapprove the application, and the reasons for the recommendation.

Subp. 2.

Written notice to center.

The applicant center shall be sent written notice of approval, deferral, or disapproval within 30 days of the completion of the site visit. If the decision is a deferral or a disapproval, the notice shall indicate the specific areas of noncompliance.

Subp. 3.

Noncompliance with statutes and rules.

An application shall be disapproved or deferred if it is the initial application of a center, when the applicant center is not in compliance with Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.

Subp. 4.

Deferral of application.

If an application is deferred, the length of deferral shall not exceed 180 days. If the areas of noncompliance stated in the deferral notice are not satisfactorily corrected by the end of the deferral period, the application shall be disapproved. The applicant center shall allow the commissioner to inspect the center at any time during the deferral period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center. At any time during the deferral period, the applicant center may submit documentation indicating correction of noncompliance. The application shall then be approved or disapproved. At any time during the deferral period, the applicant center may submit a written request to the commissioner to change the application status to disapproval. The request shall be complied with within 14 days of receiving this written request. The applicant center is not an approved center for purposes of Minnesota Statutes, section 62A.152 during a deferral period.

Subp. 5.

Effective date of decision.

The effective date of a decision is the date the commissioner signs a letter notifying the applicant center of that decision.

9520.0850 APPEALS.

If an application is disapproved or approval is withdrawn, a contested case hearing and judicial review as provided in Minnesota Statutes, sections 14.48 to 14.69, may be requested by the center within 30 days of the commissioner's decision.

9520.0860 POSTAPPROVAL REQUIREMENTS.

Subpart 1.

Duration of approval.

Initial approval of an application is valid for 12 months from the effective date, subsequent approvals for 24 months, except when approval is withdrawn according to the criteria in subpart 4.

Subp. 2.

Reapplication.

The center shall contact the department for reapplication forms, and submit the completed application at least 90 days prior to the expected expiration date. If an approved center has met the conditions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, including reapplication when required, its status as an approved center shall remain in effect pending department processing of the reapplication.

Subp. 3.

Restrictions.

The approval is issued only for the center named in the application and is not transferable or assignable to another center. The approval is issued only for the center location named in the application and is not transferable or assignable to another location. If the commissioner is notified in writing at least 30 days in advance of a change in center location and can determine that compliance with all provisions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 are maintained, the commissioner shall continue the approval of the center at the new location.

Subp. 4.

Noncompliance.

Changes in center organization, staffing, treatment, or quality assurance procedures that affect the ability of the center to comply with the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 shall be reported in writing by the center to the commissioner within 15 days of occurrence. Review of the change shall be conducted by the commissioner. A center with changes resulting in noncompliance in minimum standards shall receive written notice and may have up to 180 days to correct the areas of noncompliance before losing approval status. Interim procedures to resolve the noncompliance on a temporary basis shall be developed and submitted in writing to the commissioner for approval within 30 days of the commissioner's determination of the noncompliance. Nonreporting within 15 days of occurrence of a change that results in noncompliance, failure to develop an approved interim procedure within 30 days of the determination of the noncompliance, or nonresolution of the noncompliance within 180 days shall result in the immediate withdrawal of approval status.

Serious violation of policies or procedures, professional association or board sanctioning or loss of licensure for unethical practices, or the conviction of violating a state or federal statute shall be reported in writing by the center to the commissioner within ten days of the substantiation of such behavior. Review of this report and the action taken by the center shall be conducted by the commissioner. Approval shall be withdrawn immediately unless the commissioner determines that: the center acted with all proper haste and thoroughness in investigating the behavior, the center acted with all proper haste and thoroughness in taking appropriate disciplinary and corrective action, and that no member of the governing body was a party to the behavior. Failure to report such behavior within ten days of its substantiation shall result in immediate withdrawal of approval.

Subp. 5.

Compliance reports.

The center may be required to submit written information to the department during the approval period to document that the center has maintained compliance with the rule and center procedures. The center shall allow the commissioner to inspect the center at any time during the approval period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center.

9520.0870 VARIANCES.

Subpart 1.

When allowed.

The standards and procedures established by parts 9520.0760 to 9520.0860 may be varied by the commissioner. Standards and procedures established by statute shall not be varied.

Subp. 2.

Request procedure.

A request for a variance must be submitted in writing to the commissioner, accompanying or following the submission of a completed application for approval under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870. The request shall state:

A.

the standard or procedure to be varied;

B.

the specific reasons why the standard or procedure cannot be or should not be complied with; and

C.

the equivalent standard or procedure the center will establish to achieve the intent of the standard or procedure to be varied.

Subp. 3.

Decision procedure.

Upon receiving the variance request, the commissioner shall consult with a panel of experts in the mental health disciplines regarding the request. Criteria for granting a variance shall be the commissioner's determination that subpart 2, items A to C are met. Hardship shall not be a sufficient reason to grant a variance. No variance shall be granted that would threaten the health, safety, or rights of clients. Variances granted by the commissioner shall specify in writing the alternative standards or procedures to be implemented and any specific conditions or limitations imposed on the variance by the commissioner. Variances denied by the commissioner shall specify in writing the reason for the denial.

Subp. 4.

Notification.

The commissioner shall send the center a written notice granting or not granting the variance within 90 days of receiving the written variance request. This notice shall not be construed as approval or disapproval of the center under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.