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Minnesota Legislature

Office of the Revisor of Statutes

SF 2409

as introduced - 91st Legislature (2019 - 2020) Posted on 03/14/2019 09:04am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to human services; modifying policy provisions governing housing and
chemical and mental health;amending Minnesota Statutes 2018, sections 245G.01,
subdivisions 8, 21, by adding subdivisions; 245G.04; 245G.05; 245G.06,
subdivisions 1, 2, 4; 245G.07; 245G.08, subdivision 3; 245G.10, subdivision 4;
245G.11, subdivisions 7, 8; 245G.12; 245G.13, subdivision 1; 245G.15,
subdivisions 1, 2; 245G.18, subdivisions 3, 5; 245G.22, subdivisions 1, 2, 3, 4, 6,
7, 15, 16, 17, 19; 254B.04, by adding a subdivision; 254B.05, subdivisions 1, 5;
256B.0941, subdivisions 1, 3; 256I.03, subdivisions 8, 15; 256I.04, subdivisions
1, 2a, 2b, by adding subdivisions; 256I.05, subdivision 1c; repealing Minnesota
Statutes 2018, section 256I.05, subdivision 3.

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

ARTICLE 1

HOUSING

Section 1.

Minnesota Statutes 2018, section 256I.03, subdivision 8, is amended to read:


Subd. 8.

Supplementary services.

"Supplementary services" means housing support
services provided to individuals in addition to room and board including, but not limited
to, oversight and up to 24-hour supervision, medication reminders, assistance with
transportation, arranging for meetings and appointments, deleted text beginanddeleted text end arranging for medical and
social servicesnew text begin, and services identified in section 256I.03, subdivision 12new text end.

Sec. 2.

Minnesota Statutes 2018, section 256I.03, subdivision 15, is amended to read:


Subd. 15.

Supportive housing.

"Supportive housing" means housing deleted text beginwith support
services according to the continuum of care coordinated assessment system established
under Code of Federal Regulations, title 24, section 578.3
deleted text endnew text begin that is not time-limited and
provides or coordinates services necessary for a resident to maintain housing stability
new text end.

Sec. 3.

Minnesota Statutes 2018, section 256I.04, subdivision 1, is amended to read:


Subdivision 1.

Individual eligibility requirements.

An individual is eligible for and
entitled to a housing support payment to be made on the individual's behalf if the agency
has approved the setting where the individual will receive housing support and the individual
meets the requirements in paragraph (a), (b), or (c).

(a) The individual is aged, blind, or is over 18 years of age with a disability as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2
, is less than the monthly rate specified in the agency's agreement with the
provider of housing support in which the individual resides.

(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (4) to (8), and (13), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of housing support in which the
individual resides.

(c) The individual receives licensed residential crisis stabilization services under section
256B.0624, subdivision 7, and is receiving medical assistance. The individual may receive
concurrent housing support payments if receiving licensed residential crisis stabilization
services under section 256B.0624, subdivision 7.

new text begin (d) An individual who receives ongoing rental subsidies is not eligible for housing
support payments under paragraph (a) or (b).
new text end

Sec. 4.

Minnesota Statutes 2018, section 256I.04, subdivision 2a, is amended to read:


Subd. 2a.

License required; staffing qualifications.

(a) Except as provided in paragraph
(b), an agency may not enter into an agreement with an establishment to provide housing
support unless:

(1) the establishment is licensed by the Department of Health as a hotel and restaurant;
a board and lodging establishment; a boarding care home before March 1, 1985; or a
supervised living facility, and the service provider for residents of the facility is licensed
under chapter 245A. However, an establishment licensed by the Department of Health to
provide lodging need not also be licensed to provide board if meals are being supplied to
residents under a contract with a food vendor who is licensed by the Department of Health;

(2) the residence is: (i) licensed by the commissioner of human services under Minnesota
Rules, parts 9555.5050 to 9555.6265; (ii) certified by a county human services agency prior
to July 1, 1992, using the standards under Minnesota Rules, parts 9555.5050 to 9555.6265;
(iii) licensed by the commissioner under Minnesota Rules, parts 2960.0010 to 2960.0120,
with a variance under section 245A.04, subdivision 9; or (iv) licensed under section 245D.02,
subdivision 4a
, as a community residential setting by the commissioner of human services;
or

(3) the establishment is registered under chapter 144D and provides three meals a day.

(b) The requirements under paragraph (a) do not apply to establishments exempt from
state licensure because they are:

(1) located on Indian reservations and subject to tribal health and safety requirements;
or

(2) deleted text begina supportive housing establishment that has an approved habitability inspection and
an individual lease agreement and that serves people who have experienced long-term
homelessness and were referred through a coordinated assessment in section 256I.03,
subdivision 15
deleted text endnew text begin supportive housing establishments where an individual has an approved
habitability inspection and an individual lease agreement
new text end.

(c) Supportive housing establishments new text begin that serve individuals who have experienced
long-term homelessness
new text endand emergency shelters must participate in the homeless management
information systemnew text begin and a coordinated assessment system as defined by the commissionernew text end.

(d) Effective July 1, 2016, an agency shall not have an agreement with a provider of
housing support unless all staff members who have direct contact with recipients:

(1) have skills and knowledge acquired through one or more of the following:

(i) a course of study in a health- or human services-related field leading to a bachelor
of arts, bachelor of science, or associate's degree;

(ii) one year of experience with the target population served;

(iii) experience as a mental health certified peer specialist according to section 256B.0615;
or

(iv) meeting the requirements for unlicensed personnel under sections 144A.43 to
144A.483;

(2) hold a current driver's license appropriate to the vehicle driven if transporting
recipients;

(3) complete training on vulnerable adults mandated reporting and child maltreatment
mandated reporting, where applicable; and

(4) complete housing support orientation training offered by the commissioner.

Sec. 5.

Minnesota Statutes 2018, section 256I.04, subdivision 2b, is amended to read:


Subd. 2b.

Housing support agreements.

(a) Agreements between agencies and providers
of housing support must be in writing on a form developed and approved by the commissioner
and must specify the name and address under which the establishment subject to the
agreement does business and under which the establishment, or service provider, if different
from the group residential housing establishment, is licensed by the Department of Health
or the Department of Human Services; the specific license or registration from the
Department of Health or the Department of Human Services held by the provider and the
number of beds subject to that license; the address of the location or locations at which
group residential housing is provided under this agreement; the per diem and monthly rates
that are to be paid from housing support funds for each eligible resident at each location;
the number of beds at each location which are subject to the agreement; whether the license
holder is a not-for-profit corporation under section 501(c)(3) of the Internal Revenue Code;
and a statement that the agreement is subject to the provisions of sections 256I.01 to 256I.06
and subject to any changes to those sections.

(b) Providers are required to verify the following minimum requirements in the
agreement:

(1) current license or registration, including authorization if managing or monitoring
medications;

(2) all staff who have direct contact with recipients meet the staff qualifications;

(3) the provision of housing support;

(4) the provision of supplementary services, if applicable;

(5) reports of adverse events, including recipient death or serious injury; deleted text beginand
deleted text end

(6) submission of residency requirements that could result in recipient evictiondeleted text begin.deleted text endnew text begin; and
new text end

new text begin (7) that the provider complies with the prohibition on limiting or restricting the number
of hours an applicant or recipient is employed, as specified in subdivision 5.
new text end

(c) Agreements may be terminated with or without cause by the commissioner, the
agency, or the provider with two calendar months prior notice. The commissioner may
immediately terminate an agreement under subdivision 2d.

Sec. 6.

Minnesota Statutes 2018, section 256I.04, is amended by adding a subdivision to
read:


new text begin Subd. 2h. new text end

new text begin Required supplementary services. new text end

new text begin A provider of supplementary services
shall ensure that a recipient has, at a minimum, assistance with services as identified in the
recipient's professional statement of need under section 256I.03, subdivision 12. A provider
of supplementary services shall maintain case notes with the date and description of services
provided to each recipient.
new text end

Sec. 7.

Minnesota Statutes 2018, section 256I.04, is amended by adding a subdivision to
read:


new text begin Subd. 5. new text end

new text begin Employment. new text end

new text begin A provider is prohibited from limiting or restricting the number
of hours an applicant or recipient is employed.
new text end

Sec. 8.

Minnesota Statutes 2018, section 256I.05, subdivision 1c, is amended to read:


Subd. 1c.

Rate increases.

An agency may not increase the rates negotiated for housing
support above those in effect on June 30, 1993, except as provided in paragraphs (a) to (f).

(a) An agency may increase the rates for room and board to the MSA equivalent rate
for those settings whose current rate is below the MSA equivalent rate.

(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total housing support rate for these residents must not exceed the
maximum rate specified in subdivisions 1 and 1a. Agencies must not include nor increase
difficulty of care rates for adults in foster care whose difficulty of care is eligible for funding
by home and community-based waiver programs under title XIX of the Social Security Act.

(c) The room and board rates will be increased each year when the MSA equivalent rate
is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, less
the amount of the increase in the medical assistance personal needs allowance under section
256B.35.

(d) When housing support pays for an individual's room and board, or other costs
necessary to provide room and board, the rate payable to the residence must continue for
up to 18 calendar days per incident that the person is temporarily absent from the residence,
not to exceed 60 days in a calendar year, if the absence or absences deleted text beginhave received the prior
approval of
deleted text endnew text begin are reported in advance tonew text end the county agency's social service staff. deleted text beginPrior approvaldeleted text endnew text begin
Advance reporting
new text end is not required for emergency absences due to crisis, illness, or injury.

(e) For facilities meeting substantial change criteria within the prior year. Substantial
change criteria exists if the establishment experiences a 25 percent increase or decrease in
the total number of its beds, if the net cost of capital additions or improvements is in excess
of 15 percent of the current market value of the residence, or if the residence physically
moves, or changes its licensure, and incurs a resulting increase in operation and property
costs.

(f) Until June 30, 1994, an agency may increase by up to five percent the total rate paid
for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of health as a boarding care home,
but are not certified for the purposes of the medical assistance program. However, an increase
under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical
assistance reimbursement rate for nursing home resident class A, in the geographic grouping
in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to
9549.0058.

Sec. 9. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2018, section 256I.05, subdivision 3, new text end new text begin is repealed.
new text end

ARTICLE 2

CHEMICAL AND MENTAL HEALTH

Section 1.

Minnesota Statutes 2018, section 245G.01, subdivision 8, is amended to read:


Subd. 8.

Client.

"Client" means an individual accepted by a license holder for assessment
or treatment of a substance use disorder. An individual remains a client until the license
holder no longer provides or intends to provide the individual with treatment service.new text begin Client
also includes the meaning of patient under section 144.651, subdivision 2.
new text end

Sec. 2.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 10a. new text end

new text begin Day of service initiation. new text end

new text begin "Day of service initiation" means the day the
license holder begins the provision of a treatment service identified in section 245G.07.
new text end

Sec. 3.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 20a. new text end

new text begin Person-centered. new text end

new text begin "Person-centered" means a client actively participates in
the client's treatment planning of services. This includes a client making meaningful and
informed choices about the client's own goals, objectives, and the services the client receives
in collaboration with the client's identified natural supports.
new text end

Sec. 4.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 20b. new text end

new text begin Staff or staff member. new text end

new text begin "Staff" or "staff member" means an individual who
works under the direction of the license holder regardless of the individual's employment
status including but not limited to an intern, consultant, individual who works part time, or
individual who does not provide direct care services.
new text end

Sec. 5.

Minnesota Statutes 2018, section 245G.01, subdivision 21, is amended to read:


Subd. 21.

Student intern.

"Student intern" means an individual who is new text beginenrolled in a
program specializing in alcohol and drug counseling or mental health counseling at an
accredited educational institution and is
new text endauthorized by a licensing board to provide services
under supervision of a licensed professional.

Sec. 6.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 28. new text end

new text begin Treatment week. new text end

new text begin "Treatment week" means the seven-day period that the
program identified in the program's policy and procedure manual as the day of the week
that the treatment program week starts and ends for the purpose of identifying the nature
and number of treatment services an individual receives weekly.
new text end

Sec. 7.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 29. 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 or an activity to a client without compensation.
new text end

Sec. 8.

Minnesota Statutes 2018, section 245G.04, is amended to read:


245G.04 deleted text beginINITIAL SERVICES PLANdeleted text endnew text begin SERVICE INITIATIONnew text end.

new text begin Subdivision 1. new text end

new text begin Initial services plan. new text end

deleted text begin(a)deleted text end The license holder must complete an initial
services plan deleted text beginondeleted text endnew text begin within 24 hours ofnew text end the day of service initiation. The plan must new text beginbe
person-centered and client-specific,
new text endaddress the client's immediate health and safety concerns,
new text begin and new text endidentify the new text begintreatment new text endneedsnew text begin of the clientnew text end to be addressed deleted text beginin the first treatment session,
and make treatment suggestions for the client
deleted text end during the time between deleted text beginintakedeleted text endnew text begin the day of
service initiation
new text end and deleted text begincompletiondeleted text endnew text begin developmentnew text end of the individual treatment plan.

new text begin Subd. 2. new text end

new text begin Vulnerable adult status. new text end

deleted text begin(b) The initial services plan must include a
determination of
deleted text end new text begin(a) Within 24 hours of the day of service initiation, a nonresidential program
must determine
new text endwhether a client is a vulnerable adult as defined in section 626.5572,
subdivision 21
. An adult client of a residential program is a vulnerable adult.

new text begin (b)new text end An individual abuse prevention plan, according to sections 245A.65, subdivision 2,
paragraph (b), and 626.557, subdivision 14, paragraph (b), is required for a client who meets
the definition of vulnerable adult.

Sec. 9.

Minnesota Statutes 2018, section 245G.05, is amended to read:


245G.05 COMPREHENSIVE ASSESSMENT AND ASSESSMENT SUMMARY.

Subdivision 1.

Comprehensive assessment.

(a) A comprehensive assessment of the
client's substance use disorder must be administered face-to-face by an alcohol and drug
counselor within three calendar days deleted text beginafterdeleted text endnew text begin from the day ofnew text end service initiation for a residential
program or deleted text beginduring the initial session for all other programsdeleted text endnew text begin within three sessions of the day
of service initiation for a client in a nonresidential program
new text end. If the comprehensive assessment
is not completed deleted text beginduring the initial session,deleted text end new text beginwithin the required time frame, new text endthe deleted text beginclient-centereddeleted text endnew text begin
person-centered
new text end reason for the delaynew text begin and the planned completion datenew text end must be documented
in the client's file deleted text beginand the planned completion datedeleted text end. new text beginThe comprehensive assessment is
complete upon a qualified staff member's dated signature.
new text endIf the client received a
comprehensive assessment that authorized the treatment service, an alcohol and drug
counselor new text beginmay use the comprehensive assessment for requirements of this subdivision but
new text end must new text begindocument a new text endreview deleted text beginthedeleted text end new text beginof the comprehensive new text endassessmentnew text begin and update the comprehensive
assessment as necessary
new text end to deleted text begindeterminedeleted text endnew text begin ensurenew text end compliance with this subdivisiondeleted text begin, includingdeleted text endnew text begin
within
new text end applicable timelines. deleted text beginIf available, the alcohol and drug counselor may use current
information provided by a referring agency or other source as a supplement. Information
gathered more than 45 days before the date of admission is not considered current.
deleted text end The
comprehensive assessment must include sufficient information to complete the assessment
summary according to subdivision 2 and the individual treatment plan according to section
245G.06. The comprehensive assessment must include information about the client's needs
that relate to substance use and personal strengths that support recovery, including:

(1) age, sex, cultural background, sexual orientation, living situation, economic status,
and level of education;

(2) new text begina description of the new text endcircumstances new text beginon the day new text endof service initiation;

(3) new text begina list of new text endprevious attempts at treatment for substance misuse or substance use disorder,
compulsive gambling, or mental illness;

(4) new text begina list of new text endsubstance use history including amounts and types of substances used,
frequency and duration of use, periods of abstinence, and circumstances of relapse, if any.
For each substance used within the previous 30 days, the information must include the date
of the most recent use and new text beginaddress the absence or presence of new text endprevious withdrawal symptoms;

(5) specific problem behaviors exhibited by the client when under the influence of
substances;

(6) deleted text beginfamily statusdeleted text endnew text begin the client's desire for family involvement in the treatment programnew text end,
family historynew text begin of substance use and misusenew text end, deleted text beginincludingdeleted text end history or presence of physical or
sexual abuse, new text beginand new text endlevel of family supportdeleted text begin, and substance misuse or substance use disorder
of a family member or significant other
deleted text end;

(7) physical new text beginand medical new text endconcerns or diagnoses, deleted text beginthe severity of the concerns, anddeleted text endnew text begin current
medical treatment needed or being received related to the diagnoses, and
new text end whether the
concerns deleted text beginare being addressed by adeleted text endnew text begin need to be referred to an appropriatenew text end health care
professional;

(8) mental health history deleted text beginand psychiatric statusdeleted text end, including symptomsdeleted text begin, disability,deleted text endnew text begin and the
effect on the client's ability to function;
new text end current new text beginmental health new text endtreatment deleted text beginsupports,deleted text endnew text begin;new text end and
psychotropic medication needed to maintain stabilitydeleted text begin;deleted text endnew text begin.new text end The assessment must utilize screening
tools approved by the commissioner pursuant to section 245.4863 to identify whether the
client screens positive for co-occurring disorders;

(9) arrests and legal interventions related to substance use;

(10) new text begina description of how the client's use affected the client's new text endability to function
appropriately in work and educational settings;

(11) ability to understand written treatment materials, including rules and the client's
rights;

(12) new text begina description of any new text endrisk-taking behavior, including behavior that puts the client at
risk of exposure to blood-borne or sexually transmitted diseases;

(13) social network in relation to expected support for recovery deleted text beginanddeleted text endnew text begin;
new text end

new text begin (14)new text end leisure time activities that are associated with substance use;

deleted text begin (14)deleted text endnew text begin (15)new text end whether the client is pregnant and, if so, the health of the unborn child and the
client's current involvement in prenatal care;

deleted text begin (15)deleted text endnew text begin (16)new text end whether the client recognizes deleted text beginproblemsdeleted text endnew text begin needsnew text end related to substance use and is
willing to follow treatment recommendations; and

deleted text begin (16) collateraldeleted text endnew text begin (17)new text end informationnew text begin from a collateral contact may be included, but is not
required
new text end. deleted text beginIf the assessor gathered sufficient information from the referral source or the client
to apply the criteria in Minnesota Rules, parts 9530.6620 and 9530.6622, a collateral contact
is not required.
deleted text end

(b) If the client is identified as having opioid use disorder or seeking treatment for opioid
use disorder, the program must provide educational information to the client concerning:

(1) risks for opioid use disorder and dependence;

(2) treatment options, including the use of a medication for opioid use disorder;

(3) the risk of and recognizing opioid overdose; and

(4) the use, availability, and administration of naloxone to respond to opioid overdose.

(c) The commissioner shall develop educational materials that are supported by research
and updated periodically. The license holder must use the educational materials that are
approved by the commissioner to comply with this requirement.

(d) If the comprehensive assessment is completed to authorize treatment service for the
client, at the earliest opportunity during the assessment interview the assessor shall determine
if:

(1) the client is in severe withdrawal and likely to be a danger to self or others;

(2) the client has severe medical problems that require immediate attention; or

(3) the client has severe emotional or behavioral symptoms that place the client or others
at risk of harm.

If one or more of the conditions in clauses (1) to (3) are present, the assessor must end the
assessment interview and follow the procedures in the program's medical services plan
under section 245G.08, subdivision 2, to help the client obtain the appropriate services. The
assessment interview may resume when the condition is resolved.

Subd. 2.

Assessment summary.

(a) An alcohol and drug counselor must complete an
assessment summary within three calendar days deleted text beginafterdeleted text endnew text begin from the day ofnew text end service initiation for
a residential program and within three sessions deleted text beginfor all other programsdeleted text endnew text begin from the day of service
initiation for a client in a nonresidential program
new text end.new text begin The comprehensive assessment summary
is complete upon a qualified staff member's dated signature.
new text end If the comprehensive assessment
is used to authorize the treatment service, the alcohol and drug counselor must prepare an
assessment summary on the same date the comprehensive assessment is completed. If the
comprehensive assessment and assessment summary are to authorize treatment services,
the assessor must determine appropriate services for the client using the dimensions in
Minnesota Rules, part 9530.6622, and document the recommendations.

(b) An assessment summary must include:

(1) a risk description according to section 245G.05 for each dimension listed in paragraph
(c);

(2) a narrative summary supporting the risk descriptions; and

(3) a determination of whether the client has a substance use disorder.

(c) An assessment summary must contain information relevant to treatment service
planning and recorded in the dimensions in clauses (1) to (6). The license holder must
consider:

(1) Dimension 1, acute intoxication/withdrawal potential; the client's ability to cope with
withdrawal symptoms and current state of intoxication;

(2) Dimension 2, biomedical conditions and complications; the degree to which any
physical disorder of the client would interfere with treatment for substance use, and the
client's ability to tolerate any related discomfort. The license holder must determine the
impact of continued deleted text beginchemicaldeleted text endnew text begin substancenew text end use on the unborn child, if the client is pregnant;

(3) Dimension 3, emotional, behavioral, and cognitive conditions and complications;
the degree to which any condition or complication is likely to interfere with treatment for
substance use or with functioning in significant life areas and the likelihood of harm to self
or others;

(4) Dimension 4, readiness for change; the support necessary to keep the client involved
in treatment service;

(5) Dimension 5, relapse, continued use, and continued problem potential; the degree
to which the client recognizes relapse issues and has the skills to prevent relapse of either
substance use or mental health problems; and

(6) Dimension 6, recovery environment; whether the areas of the client's life are
supportive of or antagonistic to treatment participation and recovery.

Sec. 10.

Minnesota Statutes 2018, section 245G.06, subdivision 1, is amended to read:


Subdivision 1.

General.

Each client must have deleted text beginandeleted text endnew text begin a person-centerednew text end individual treatment
plan developed by an alcohol and drug counselor within deleted text beginsevendeleted text endnew text begin tennew text end days new text beginfrom the day new text endof
service initiation for a residential program and within deleted text beginthreedeleted text endnew text begin fivenew text end sessions for deleted text beginall other
programs
deleted text endnew text begin from the day of service initiation for a client in a nonresidential program. Opioid
treatment programs must complete the individual treatment plan within 21 days from the
day of service initiation
new text end. deleted text beginThe client must have active, direct involvement in selecting the
anticipated outcomes of the treatment process and developing the treatment plan.
deleted text end The
individual treatment plan must be signed by the client and the alcohol and drug counselor
and document the client's involvement in the development of the plan. deleted text beginThe plan may be a
continuation of the initial services plan required in section 245G.04.
deleted text endnew text begin The individual treatment
plan is developed upon the qualified staff member's dated signature.
new text end Treatment planning
must include ongoing assessment of client needs. An individual treatment plan must be
updated based on new information gathered about the client's conditionnew text begin, the client's level
of participation,
new text end and on whether methods identified have the intended effect. A change to
the plan must be signed by the client and the alcohol and drug counselor. deleted text beginThe plan must
provide for the involvement of the client's family and people selected by the client as
important to the success of treatment at the earliest opportunity, consistent with the client's
treatment needs and written consent.
deleted text endnew text begin If the client chooses to have family or others involved
in treatment, the client's individual treatment plan must include goals and methods identifying
how the family or others will be involved in the client's treatment.
new text end

Sec. 11.

Minnesota Statutes 2018, section 245G.06, subdivision 2, is amended to read:


Subd. 2.

Plan contents.

An individual treatment plan must be recorded in the six
dimensions listed in section 245G.05, subdivision 2, paragraph (c), must address each issue
identified in the assessment summary, prioritized according to the client's needs and focus,
and must include:

(1) specific new text begingoals and new text endmethods to address each identified neednew text begin in the comprehensive
assessment summary
new text end, including amount, frequency, and anticipated duration of treatment
service. The methods must be appropriate to the client's language, reading skills, cultural
background, and strengths;

(2) resources to refer the client to when the client's needs are to be addressed concurrently
by another providernew text begin and identification of whether the client has an assessed need of peer
support services and, if available, how peer support services are made available to the client
with an assessed need
new text end; and

(3) goals the client must reach to complete treatment and terminate services.

Sec. 12.

Minnesota Statutes 2018, section 245G.06, subdivision 4, is amended to read:


Subd. 4.

Service discharge summary.

(a) An alcohol and drug counselor must write a
new text begin service new text enddischarge summary for each client. The new text beginservice discharge new text endsummary must be
completed within five days of the client's service termination deleted text beginor within five days from the
client's or program's decision to terminate services, whichever is earlier.
deleted text endnew text begin The client's file
must include verification that the client was provided a copy of the client's service discharge
summary. If the program is unable to provide a copy of the client's service discharge summary
directly to the client, the program must document the reason.
new text end

(b) The service discharge summary must be recorded in the six dimensions listed in
section 245G.05, subdivision 2, paragraph (c), and include the following information:

(1) the client's issues, strengths, and needs while participating in treatment, including
services provided;

(2) the client's progress toward achieving each goal identified in the individual treatment
plan;

(3) a risk description according to section 245G.05; deleted text beginand
deleted text end

(4) the reasons for and circumstances of service termination. If a program discharges a
client at staff request, the reason for discharge and the procedure followed for the decision
to discharge must be documented and comply with the deleted text beginprogram's policies on staff-initiated
client discharge. If a client is discharged at staff request, the program must give the client
crisis and other referrals appropriate for the client's needs and offer assistance to the client
to access the services.
deleted text endnew text begin requirements in section 245G.14, subdivision 3, clause (3);
new text end

deleted text begin (c) For a client who successfully completes treatment, the summary must also include:
deleted text end

deleted text begin (1)deleted text end new text begin(5) new text endthe client's living arrangements at service termination;

deleted text begin (2)deleted text end new text begin(6) new text endcontinuing care recommendations, including transitions between more or less
intense services, or more frequent to less frequent services, and referrals made with specific
attention to continuity of care for mental health, as needed;new text begin and
new text end

deleted text begin (3)deleted text end new text begin(7) new text endservice termination diagnosisdeleted text begin; anddeleted text endnew text begin.
new text end

deleted text begin (4) the client's prognosis.
deleted text end

Sec. 13.

Minnesota Statutes 2018, section 245G.07, is amended to read:


245G.07 TREATMENT SERVICE.

Subdivision 1.

Treatment service.

(a) A deleted text beginlicense holderdeleted text end new text beginlicensed residential treatment
program
new text endmust deleted text beginofferdeleted text end new text beginprovide new text endthe deleted text beginfollowingdeleted text end treatment servicesnew text begin in clauses (1) to (5) to each
client
new text end, unless clinically inappropriate and the justifying clinical rationale is documenteddeleted text begin:deleted text endnew text begin.
A nonresidential treatment program must offer all treatment services in clauses (1) to (5)
and document in the individual treatment plan the specific services for which a client has
an assessed need and the plan to provide the services:
new text end

(1) individual and group counseling to help the client identify and address needs related
to substance use and develop strategies to avoid harmful substance use after discharge and
to help the client obtain the services necessary to establish a lifestyle free of the harmful
effects of substance use disorderdeleted text begin;deleted text endnew text begin. Notwithstanding subdivision 3, individual and group
counseling services must be provided by an individual who meets the staff qualifications
of an alcohol and drug counselor in section 245G.11, subdivision 5;
new text end

(2) client education strategies to avoid inappropriate substance use and health problems
related to substance use and the necessary lifestyle changes to regain and maintain health.
Client education must include information on tuberculosis education on a form approved
by the commissioner, the human immunodeficiency virus according to section 245A.19,
other sexually transmitted diseases, drug and alcohol use during pregnancy, and hepatitis.
A licensed alcohol and drug counselor must be present during an educational group;

(3) a service to help the client integrate gains made during treatment into daily living
and to reduce the client's reliance on a staff member for support;

(4) a service to address issues related to co-occurring disorders, including client education
on symptoms of mental illness, the possibility of comorbidity, and the need for continued
medication compliance while recovering from substance use disorder. A group must address
co-occurring disorders, as needed. When treatment for mental health problems is indicated,
the treatment must be integrated into the client's individual treatment plan;new text begin and
new text end

deleted text begin (5) on July 1, 2018, or upon federal approval, whichever is later, peer recovery support
services provided one-to-one by an individual in recovery. Peer support services include
education, advocacy, mentoring through self-disclosure of personal recovery experiences,
attending recovery and other support groups with a client, accompanying the client to
appointments that support recovery, assistance accessing resources to obtain housing,
employment, education, and advocacy services, and nonclinical recovery support to assist
the transition from treatment into the recovery community; and
deleted text end

deleted text begin (6) on July 1, 2018, or upon federal approval, whichever is later, caredeleted text endnew text begin (5) treatmentnew text end
coordination provided new text beginone-to-one new text endby an individual who meets the staff qualifications in
section 245G.11, subdivision 7new text begin, or an alcohol and drug counselor under section 245G.11,
subdivision 5
new text end. deleted text beginCaredeleted text endnew text begin Treatmentnew text end coordination services include:

(i) assistance in coordination with significant others to help in the treatment planning
process whenever possible;

(ii) assistance in coordination with and follow up for medical services as identified in
the treatment plan;

(iii) facilitation of referrals to substance use disorder services as indicated by a client's
medical provider, comprehensive assessment, or treatment plan;

(iv) facilitation of referrals to mental health services as identified by a client's
comprehensive assessment or treatment plan;

(v) assistance with referrals to economic assistance, social services, housing resources,
and prenatal care according to the client's needs;

(vi) life skills advocacy and support accessing treatment follow-up, disease management,
and education services, including referral and linkages to long-term services and supports
as needed; and

(vii) documentation of the provision of deleted text begincaredeleted text endnew text begin treatmentnew text end coordination services in the client's
file.

(b) A treatment service provided to a client must be provided according to the individual
treatment plan and must consider cultural differences and special needs of a client.

Subd. 2.

Additional treatment service.

A license holder may provide or arrange the
following additional treatment service as a part of the client's individual treatment plan:

(1) relationship counseling provided by a qualified professional to help the client identify
the impact of the client's substance use disorder on others and to help the client and persons
in the client's support structure identify and change behaviors that contribute to the client's
substance use disorder;

(2) therapeutic recreation to allow the client to participate in recreational activities
without the use of mood-altering chemicals and to plan and select leisure activities that do
not involve the inappropriate use of chemicals;

(3) stress management and physical well-being to help the client reach and maintain an
appropriate level of health, physical fitness, and well-being;

(4) living skills development to help the client learn basic skills necessary for independent
living;

(5) employment or educational services to help the client become financially independent;

(6) socialization skills development to help the client live and interact with others in a
positive and productive manner; deleted text beginand
deleted text end

(7) room, board, and supervision at the treatment site to provide the client with a safe
and appropriate environment to gain and practice new skillsdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (8) peer recovery support services provided one-to-one by an individual in recovery.
Peer support services include education; advocacy; mentoring through self-disclosure of
personal recovery experiences; attending recovery and other support groups with a client;
accompanying the client to appointments that support recovery; assistance accessing resources
to obtain housing, employment, education, and advocacy services; and nonclinical recovery
support to assist the transition from treatment into the recovery community.
new text end

Subd. 3.

Counselors.

A treatment service, including therapeutic recreation, must be
provided by an alcohol and drug counselor according to section 245G.11, unless the
individual providing the service is specifically qualified according to the accepted credential
required to provide the service. deleted text beginTherapeutic recreation does not include planned leisure
activities.
deleted text endnew text begin The commissioner shall maintain a current list of professionals qualified to provide
treatment services, notwithstanding the staff qualification requirements in section 245G.11,
subdivision 4.
new text end

Subd. 4.

Location of service provision.

The license holder may provide services at any
of the license holder's licensed locations or at another suitable location including a school,
government building, medical or behavioral health facility, or social service organization,
upon notification and approval of the commissioner. If services are provided off site from
the licensed site, the reason for the provision of services remotely must be documented.new text begin
The license holder may provide additional services under subdivision 2, clauses (2) to (5),
off-site if the license holder includes a policy and procedure detailing the off-site location
as a part of the treatment service description and the program abuse prevention plan.
new text end

Sec. 14.

Minnesota Statutes 2018, section 245G.08, subdivision 3, is amended to read:


Subd. 3.

Standing order protocol.

A license holder that maintains a supply of naloxone
available for emergency treatment of opioid overdose must have a written standing order
protocol by a physician who is licensed under chapter 147, that permits the license holder
to maintain a supply of naloxone on sitedeleted text begin, anddeleted text endnew text begin. A license holdernew text end must require staff to undergo
deleted text begin specificdeleted text end training in deleted text beginadministration of naloxonedeleted text endnew text begin the specific mode of administration used at
the program, which may include intranasal administration, intramuscular injection, or both
new text end.

Sec. 15.

Minnesota Statutes 2018, section 245G.10, subdivision 4, is amended to read:


Subd. 4.

Staff requirement.

It is the responsibility of the license holder to determine
an acceptable group size based on each client's needs except that treatment services provided
in a group shall not exceed 16 clients. deleted text beginA counselor in an opioid treatment program must not
supervise more than 50 clients.
deleted text end The license holder must maintain a record that documents
compliance with this subdivision.

Sec. 16.

Minnesota Statutes 2018, section 245G.11, subdivision 7, is amended to read:


Subd. 7.

deleted text beginCaredeleted text endnew text begin Treatmentnew text end coordination provider qualifications.

(a) deleted text beginCaredeleted text endnew text begin Treatmentnew text end
coordination must be provided by qualified staff. An individual is qualified to provide deleted text begincaredeleted text endnew text begin
treatment
new text end coordination if the individualdeleted text begin:deleted text endnew text begin meets the qualifications of an alcohol and drug
counselor under subdivision 5. An individual who does not meet the qualifications of an
alcohol and drug counselor under subdivision 5 is qualified to provide treatment coordination
if the individual:
new text end

(1) is skilled in the process of identifying and assessing a wide range of client needs;

(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;

(3) has successfully completed 30 hours of classroom instruction on deleted text begincaredeleted text endnew text begin treatmentnew text end
coordination for an individual with substance use disorder;

(4) has either:

(i) a bachelor's degree in one of the behavioral sciences or related fields; or

(ii) current certification as an alcohol and drug counselor, level I, by the Upper Midwest
Indian Council on Addictive Disorders; and

(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.

(b) A deleted text begincaredeleted text endnew text begin treatmentnew text end coordinator must receive at least one hour of supervision regarding
individual service delivery from an alcohol and drug counselor weekly.

Sec. 17.

Minnesota Statutes 2018, section 245G.11, subdivision 8, is amended to read:


Subd. 8.

Recovery peer qualifications.

A recovery peer must:

(1) have a high school diploma or its equivalent;

(2) have a minimum of one year in recovery from substance use disorder;

(3) hold a current credential from deleted text begina certification body approved by the commissioner
that demonstrates
deleted text endnew text begin the Minnesota Certification Board, the Upper Midwest Indian Council
on Addictive Disorders, or the National Association for Alcoholism and Drug Abuse
Counselors. An individual may also receive a credential from a tribal nation when providing
peer recovery support services in a tribally licensed program. The credential must demonstrate
new text end
skills and training in the domains of ethics and boundaries, advocacy, mentoring and
education, and recovery and wellness support; and

(4) receive ongoing supervision in areas specific to the domains of the recovery peer's
role by an alcohol and drug counselor deleted text beginor an individual with a certification approved by the
commissioner
deleted text end.

Sec. 18.

Minnesota Statutes 2018, section 245G.12, is amended to read:


245G.12 PROVIDER POLICIES AND PROCEDURES.

A license holder must develop a written policies and procedures manual, indexed
according to section 245A.04, subdivision 14, paragraph (c), that provides staff members
immediate access to all policies and procedures and provides a client and other authorized
parties access to all policies and procedures. The manual must contain the following
materials:

(1) assessment and treatment planning policies, including screening for mental health
concerns and treatment objectives related to the client's identified mental health concerns
in the client's treatment plan;

(2) policies and procedures regarding HIV according to section 245A.19;

(3) the license holder's methods and resources to provide information on tuberculosis
and tuberculosis screening to each client and to report a known tuberculosis infection
according to section 144.4804;

(4) personnel policies according to section 245G.13;

(5) policies and procedures that protect a client's rights according to section 245G.15;

(6) a medical services plan according to section 245G.08;

(7) emergency procedures according to section 245G.16;

(8) policies and procedures for maintaining client records according to section 245G.09;

(9) procedures for reporting the maltreatment of minors according to section 626.556,
and vulnerable adults according to sections 245A.65, 626.557, and 626.5572;

(10) a description of treatment services, including the amount and type of services
providednew text begin and the program's treatment weeknew text end;

(11) the methods used to achieve desired client outcomes;

(12) the hours of operation; and

(13) the target population served.

Sec. 19.

Minnesota Statutes 2018, section 245G.13, subdivision 1, is amended to read:


Subdivision 1.

Personnel policy requirements.

A license holder must have written
personnel policies that are available to each staff member. The personnel policies must:

(1) ensure that staff member retention, promotion, job assignment, or pay are not affected
by a good faith communication between a staff member and the department, the Department
of Health, the ombudsman for mental health and developmental disabilities, law enforcement,
or a local agency for the investigation of a complaint regarding a client's rights, health, or
safety;

(2) contain a job description for each staff member position specifying responsibilities,
degree of authority to execute job responsibilities, and qualification requirements;

(3) provide for a job performance evaluation based on standards of job performance
conducted on a regular and continuing basis, including a written annual review;

(4) describe behavior that constitutes grounds for disciplinary action, suspension, or
dismissal, including policies that address staff member problematic substance use and the
requirements of section 245G.11, subdivision 1, policies prohibiting personal involvement
with a client in violation of chapter 604, and policies prohibiting client abuse described in
sections 245A.65, 626.556, 626.557, and 626.5572;

(5) identify how the program will identify whether behaviors or incidents are problematic
substance use, including a description of how the facility must address:

(i) receiving treatment for substance use within the period specified for the position in
the staff qualification requirements, including medication-assisted treatment;

(ii) substance use that negatively impacts the staff member's job performance;

(iii) deleted text beginchemicaldeleted text endnew text begin substancenew text end use that affects the credibility of treatment services with a client,
referral source, or other member of the community;

(iv) symptoms of intoxication or withdrawal on the job; and

(v) the circumstances under which an individual who participates in monitoring by the
health professional services program for a substance use or mental health disorder is able
to provide services to the program's clients;

(6) include a chart or description of the organizational structure indicating lines of
authority and responsibilities;

(7) include orientation within 24 working hours of starting for each new staff member
based on a written plan that, at a minimum, must provide training related to the staff member's
specific job responsibilities, policies and procedures, client confidentiality, HIV minimum
standards, and client needs; and

(8) include policies outlining the license holder's response to a staff member with a
behavior problem that interferes with the provision of treatment service.

Sec. 20.

Minnesota Statutes 2018, section 245G.15, subdivision 1, is amended to read:


Subdivision 1.

Explanation.

A client has the rights identified in sections 144.651,
148F.165, and 253B.03, as applicable. The license holder must give each client deleted text beginatdeleted text endnew text begin on the
day of
new text end service initiation a written statement of the client's rights and responsibilities. A staff
member must review the statement with a client at that time.

Sec. 21.

Minnesota Statutes 2018, section 245G.15, subdivision 2, is amended to read:


Subd. 2.

Grievance procedure.

deleted text beginAtdeleted text endnew text begin On the day ofnew text end service initiation, the license holder
must explain the grievance procedure to the client or the client's representative. The grievance
procedure must be posted in a place visible to clients, and made available upon a client's or
former client's request. The grievance procedure must require that:

(1) a staff member helps the client develop and process a grievance;

(2) current telephone numbers and 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 the Board
of Behavioral Health and Therapy, when applicable, be made available to a client; and

(3) a license holder responds to the client's grievance within three days of a staff member's
receipt of the grievance, and the client may bring the grievance to the highest level of
authority in the program if not resolved by another staff member.

Sec. 22.

Minnesota Statutes 2018, section 245G.18, subdivision 3, is amended to read:


Subd. 3.

Staff ratios.

deleted text beginAt least 25 percent of a counselor's scheduled work hours must
be allocated to indirect services, including documentation of client services, coordination
of services with others, treatment team meetings, and other duties.
deleted text end A counseling group
consisting entirely of adolescents must not exceed 16 adolescents. It is the responsibility of
the license holder to determine an acceptable group size based on the needs of the clients.

Sec. 23.

Minnesota Statutes 2018, section 245G.18, subdivision 5, is amended to read:


Subd. 5.

Program requirements.

In addition to the requirements specified in the client's
treatment plan under section 245G.06, programs serving an adolescent must include:

(1) coordination with the school system to address the client's academic needs;

(2) when appropriate, a plan that addresses the client's leisure activities without deleted text beginchemicaldeleted text endnew text begin
substance
new text end use; and

(3) a plan that addresses family involvement in the adolescent's treatment.

Sec. 24.

Minnesota Statutes 2018, section 245G.22, subdivision 1, is amended to read:


Subdivision 1.

Additional requirements.

(a) An opioid treatment program licensed
under this chapter must alsonew text begin: (1)new text end comply with the requirements of this section and Code of
Federal Regulations, title 42, part 8deleted text begin. When federal guidance or interpretations are issued on
federal standards or requirements also required under this section, the federal guidance or
interpretations shall apply.
deleted text endnew text begin; (2) be registered as a narcotic treatment program with the Drug
Enforcement Administration; (3) be accredited through an accreditation body approved by
the Division of Pharmacologic Therapy of the Center for Substance Abuse Treatment; (4)
be certified through the Division of Pharmacologic Therapy of the Center for Substance
Abuse Treatment; and (5) hold a license from the Minnesota Board of Pharmacy or equivalent
agency.
new text end

(b) Where a standard in this section differs from a standard in an otherwise applicable
administrative rule or statute, the standard of this section applies.

Sec. 25.

Minnesota Statutes 2018, section 245G.22, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(b) "Diversion" means the use of a medication for the treatment of opioid addiction being
diverted from intended use of the medication.

(c) "Guest dose" means administration of a medication used for the treatment of opioid
addiction to a person who is not a client of the program that is administering or dispensing
the medication.

(d) "Medical director" means a deleted text beginphysiciandeleted text endnew text begin practitionernew text end licensed to practice medicine in
the jurisdiction that the opioid treatment program is located who assumes responsibility for
administering all medical services performed by the program, either by performing the
services directly or by delegating specific responsibility to deleted text begin(1) authorized program physicians;
(2) advanced practice registered nurses, when approved by variance by the State Opioid
Treatment Authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration; or (3) health care professionals functioning under the
medical director's direct supervision
deleted text endnew text begin a practitioner of the opioid treatment programnew text end.

(e) "Medication used for the treatment of opioid use disorder" means a medication
approved by the Food and Drug Administration for the treatment of opioid use disorder.

(f) "Minnesota health care programs" has the meaning given in section 256B.0636.

(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations,
title 42, section 8.12, and includes programs licensed under this chapter.

(h) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605,
subpart 21a.

new text begin (i) "Practitioner" means a staff member holding a current, unrestricted license to practice
medicine issued by the Board of Medical Practice or nursing issued by the Board of Nursing
and is currently registered with the Drug Enforcement Administration to order or dispense
controlled substances in Schedules II to V under the Controlled Substances Act, United
States Code, title 21, part B, section 821. Practitioner includes an advanced practice registered
nurse and physician assistant if the staff member receives a variance by the state opioid
treatment authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration.
new text end

deleted text begin (i)deleted text endnew text begin (j)new text end "Unsupervised use" means the use of a medication for the treatment of opioid use
disorder dispensed for use by a client outside of the program setting.

Sec. 26.

Minnesota Statutes 2018, section 245G.22, subdivision 3, is amended to read:


Subd. 3.

Medication orders.

Before the program may administer or dispense a medication
used for the treatment of opioid use disorder:

(1) a client-specific order must be received from an appropriately credentialed deleted text beginphysiciandeleted text endnew text begin
practitioner
new text end who is enrolled as a Minnesota health care programs provider and meets all
applicable provider standards;

(2) the signed order must be documented in the client's record; and

(3) if the deleted text beginphysiciandeleted text endnew text begin practitionernew text end that issued the order is not able to sign the order when
issued, the unsigned order must be entered in the client record at the time it was received,
and the deleted text beginphysiciandeleted text endnew text begin practitionernew text end must review the documentation and sign the order in the
client's record within 72 hours of the medication being ordered. The license holder must
report to the commissioner any medication error that endangers a client's health, as
determined by the medical director.

Sec. 27.

Minnesota Statutes 2018, section 245G.22, subdivision 4, is amended to read:


Subd. 4.

High dose requirements.

A client being administered or dispensed a dose
beyond that set forth in subdivision 6, paragraph (a), deleted text beginclause (1),deleted text end that exceeds 150 milligrams
of methadone or 24 milligrams of buprenorphine daily, and for each subsequent increase,
must meet face-to-face with a prescribing deleted text beginphysiciandeleted text endnew text begin practitionernew text end. The meeting must occur
before the administration or dispensing of the increased medication dose.

Sec. 28.

Minnesota Statutes 2018, section 245G.22, subdivision 6, is amended to read:


Subd. 6.

Criteria for unsupervised use.

(a) To limit the potential for diversion of
medication used for the treatment of opioid use disorder to the illicit market, medication
dispensed to a client for unsupervised use shall be subject to the deleted text beginfollowingdeleted text end requirementsdeleted text begin:deleted text endnew text begin
of this subdivision.
new text end

deleted text begin (1)deleted text end Any client in an opioid treatment program may receive a single unsupervised use
dose for a day that the clinic is closed for business, including Sundays and state and federal
holidaysdeleted text begin; anddeleted text endnew text begin.
new text end

deleted text begin (2) other treatment program decisions on dispensing medications used for the treatment
of opioid use disorder to a client for unsupervised use shall be determined by the medical
director.
deleted text end

(b) deleted text beginIn determining whether a client may be permitted unsupervised use of medications,
a physician
deleted text endnew text begin A practitionernew text end with authority to prescribe must deleted text beginconsiderdeleted text endnew text begin review and documentnew text end
the criteria in deleted text beginthisdeleted text end paragraphdeleted text begin. The criteria in this paragraph must also be considereddeleted text endnew text begin (c)new text end when
determining whether dispensing medication for a client's unsupervised use is appropriate
to new text beginimplement, new text endincreasenew text begin,new text end or deleted text begintodeleted text end extend the amount of time between visits to the program. The
criteria are:

(1) absence of recent abuse of drugs including but not limited to opioids, non-narcotics,
and alcohol;

(2) regularity of program attendance;

(3) absence of serious behavioral problems at the program;

(4) absence of known recent criminal activity such as drug dealing;

(5) stability of the client's home environment and social relationships;

(6) length of time in comprehensive maintenance treatment;

(7) reasonable assurance that unsupervised use medication will be safely stored within
the client's home; and

(8) whether the rehabilitative benefit the client derived from decreasing the frequency
of program attendance outweighs the potential risks of diversion or unsupervised use.

(c) The determination, including the basis of the determination must be documented in
the client's medical record.

Sec. 29.

Minnesota Statutes 2018, section 245G.22, subdivision 7, is amended to read:


Subd. 7.

Restrictions for unsupervised use of methadone hydrochloride.

(a) If a
deleted text begin physician with authority to prescribedeleted text endnew text begin medical director or prescribing practitioner assesses
and
new text end determines that a client meets the criteria in subdivision 6 and may be dispensed a
medication used for the treatment of opioid addiction, the restrictions in this subdivision
must be followed when the medication to be dispensed is methadone hydrochloride.new text begin The
results of the assessment must be contained in the client file.
new text end

(b) During the first 90 days of treatment, the unsupervised use medication supply must
be limited to a maximum of a single dose each week and the client shall ingest all other
doses under direct supervision.

(c) In the second 90 days of treatment, the unsupervised use medication supply must be
limited to two doses per week.

(d) In the third 90 days of treatment, the unsupervised use medication supply must not
exceed three doses per week.

(e) In the remaining months of the first year, a client may be given a maximum six-day
unsupervised use medication supply.

(f) After one year of continuous treatment, a client may be given a maximum two-week
unsupervised use medication supply.

(g) After two years of continuous treatment, a client may be given a maximum one-month
unsupervised use medication supply, but must make monthly visits to the program.

Sec. 30.

Minnesota Statutes 2018, section 245G.22, subdivision 15, is amended to read:


Subd. 15.

Nonmedication treatment services; documentation.

(a) The program must
offer at least 50 consecutive minutes of individual or group therapy treatment services as
defined in section 245G.07, subdivision 1, paragraph (a), clause (1), per week, for the first
ten weeks following admission, and at least 50 consecutive minutes per month thereafter.
As clinically appropriate, the program may offer these services cumulatively and not
consecutively in increments of no less than 15 minutes over the required time period, and
for a total of 60 minutes of treatment services over the time period, and must document the
reason for providing services cumulatively in the client's record. The program may offer
additional levels of service when deemed clinically necessary.

(b) Notwithstanding the requirements of comprehensive assessments in section 245G.05,
the assessment must be completed within 21 days new text beginfrom the day new text endof service initiation.

(c) Notwithstanding the requirements of individual treatment plans set forth in section
245G.06:

(1) treatment plan contents for a maintenance client are not required to include goals
the client must reach to complete treatment and have services terminated;

(2) treatment plans for a client in a taper or detox status must include goals the client
must reach to complete treatment and have services terminated;

(3) for the initial ten weeks after admission for all new admissions, readmissions, and
transfers, deleted text beginprogress notesdeleted text endnew text begin a weekly treatment plan reviewnew text end must be deleted text beginentered in a client's file at
least weekly and be recorded in each of the six dimensions upon the development of the
treatment plan and thereafter
deleted text endnew text begin documented upon the completion of the treatment plan. Prior
to the completion of the treatment plan, all services must be documented according to section
245G.06, subdivision 3
new text end. Subsequently, the counselor must document deleted text beginprogressdeleted text endnew text begin treatment
plan reviews
new text end in the six dimensions at least once monthlynew text begin after the initial ten weeksnew text end or, when
clinical need warrants, more frequentlydeleted text begin; anddeleted text endnew text begin.
new text end

deleted text begin (4) upon the development of the treatment plan and thereafter, treatment plan reviews
must occur weekly, or after each treatment service, whichever is less frequent, for the first
ten weeks after the treatment plan is developed. Following the first ten weeks of treatment
plan reviews, reviews may occur monthly, unless the client's needs warrant more frequent
revisions or documentation.
deleted text end

Sec. 31.

Minnesota Statutes 2018, section 245G.22, subdivision 16, is amended to read:


Subd. 16.

Prescription monitoring program.

(a) The program must develop and
maintain a policy and procedure that requires the ongoing monitoring of the data from the
prescription monitoring program (PMP) for each client. The policy and procedure must
include how the program meets the requirements in paragraph (b).

(b) deleted text beginIfdeleted text endnew text begin Whennew text end a medication used for the treatment of substance use disorder is administered
or dispensed to a client, the license holder deleted text beginshall bedeleted text endnew text begin isnew text end subject to the following requirements:

(1) upon admission to deleted text begina methadone clinic outpatientdeleted text endnew text begin an opioidnew text end treatment program, a
client must be notified in writing that the commissioner of human services and the medical
director must monitor the PMP to review the prescribed controlled drugs a client received;

(2) the medical director or the medical director's delegate must review the data from the
PMP described in section 152.126 before the client is ordered any controlled substance, as
defined under section 152.126, subdivision 1, paragraph (c), including medications used
for the treatment of opioid addiction, and the medical director's or the medical director's
delegate's subsequent reviews of the PMP data must occur at least every 90 days;

(3) a copy of the PMP data reviewed must be maintained in the client's filenew text begin along with
the licensed practitioner's decision for frequency of ongoing PMP checks
new text end;

(4) when the PMP data contains a recent history of multiple prescribers or multiple
prescriptions for controlled substances, the physician's review of the data and subsequent
actions must be documented in the client's file within 72 hours and must contain the medical
director's determination of whether or not the prescriptions place the client at risk of harm
and the actions to be taken in response to the PMP findings. The provider must conduct
subsequent reviews of the PMP on a monthly basis; and

(5) if at any time the deleted text beginmedical directordeleted text endnew text begin licensed practitionernew text end believes the use of the
controlled substances places the client at risk of harm, the program must seek the client's
consent to discuss the client's opioid treatment with other prescribers and must seek the
client's consent for the other prescriber to disclose to the opioid treatment program's medical
director the client's condition that formed the basis of the other prescriptions. If the
information is not obtained within seven days, the medical director must document whether
or not changes to the client's medication dose or number of unsupervised use doses are
necessary until the information is obtained.

(c) The commissioner shall collaborate with the Minnesota Board of Pharmacy to develop
and implement an electronic system for the commissioner to routinely access the PMP data
to determine whether any client enrolled in an opioid addiction treatment program licensed
according to this section was prescribed or dispensed a controlled substance in addition to
that administered or dispensed by the opioid addiction treatment program. When the
commissioner determines there have been multiple prescribers or multiple prescriptions of
controlled substances for a client, the commissioner shall:

(1) inform the medical director of the opioid treatment program only that the
commissioner determined the existence of multiple prescribers or multiple prescriptions of
controlled substances; and

(2) direct the medical director of the opioid treatment program to access the data directly,
review the effect of the multiple prescribers or multiple prescriptions, and document the
review.

(d) If determined necessary, the commissioner shall seek a federal waiver of, or exception
to, any applicable provision of Code of Federal Regulations, title 42, section 2.34 (c), before
implementing this subdivision.

Sec. 32.

Minnesota Statutes 2018, section 245G.22, subdivision 17, is amended to read:


Subd. 17.

Policies and procedures.

(a) A license holder must develop and maintain the
policies and procedures required in this subdivision.

(b) For a program that is not open every day of the year, the license holder must maintain
a policy and procedure that deleted text beginpermits a client to receive a singledeleted text endnew text begin covers requirements under
section 245G.22, subdivisions 6 and 7.
new text end Unsupervised use of medication used for the treatment
of opioid use disorder for days that the program is closed for business, includingdeleted text begin,deleted text end but not
limited todeleted text begin,deleted text end Sundays and state and federal holidays deleted text beginas required under subdivision 6, paragraph
(a), clause (1)
deleted text endnew text begin, must meet the requirements under section 245G.22, subdivisions 6 and 7new text end.

(c) The license holder must maintain a policy and procedure that includes specific
measures to reduce the possibility of diversion. The policy and procedure must:

(1) specifically identify and define the responsibilities of the medical and administrative
staff for performing diversion control measures; and

(2) include a process for contacting no less than five percent of clients who have
unsupervised use of medication, excluding clients approved solely under subdivision 6,
paragraph (a), deleted text beginclause (1),deleted text end to require clients to physically return to the program each month.
The system must require clients to return to the program within a stipulated time frame and
turn in all unused medication containers related to opioid use disorder treatment. The license
holder must document all related contacts on a central log and the outcome of the contact
for each client in the client's record.new text begin The medical director must be informed of each outcome
that results in a situation in which a possible diversion issue was identified.
new text end

(d) Medication used for the treatment of opioid use disorder must be ordered,
administered, and dispensed according to applicable state and federal regulations and the
standards set by applicable accreditation entities. If a medication order requires assessment
by the person administering or dispensing the medication to determine the amount to be
administered or dispensed, the assessment must be completed by an individual whose
professional scope of practice permits an assessment. For the purposes of enforcement of
this paragraph, the commissioner has the authority to monitor the person administering or
dispensing the medication for compliance with state and federal regulations and the relevant
standards of the license holder's accreditation agency and may issue licensing actions
according to sections 245A.05, 245A.06, and 245A.07, based on the commissioner's
determination of noncompliance.

new text begin (e) A counselor in an opioid treatment program must not supervise more than 50 clients.
new text end

Sec. 33.

Minnesota Statutes 2018, section 245G.22, subdivision 19, is amended to read:


Subd. 19.

Placing authorities.

A program must provide certain notification and
client-specific updates to placing authorities for a client who is enrolled in Minnesota health
care programs. At the request of the placing authority, the program must provide
client-specific updates, including but not limited to informing the placing authority of
positive drug deleted text beginscreeningsdeleted text endnew text begin testingsnew text end and changes in medications used for the treatment of opioid
use disorder ordered for the client.

Sec. 34.

Minnesota Statutes 2018, section 254B.04, is amended by adding a subdivision
to read:


new text begin Subd. 2c. new text end

new text begin Eligibility to receive peer recovery support and treatment service
coordination.
new text end

new text begin Notwithstanding Minnesota Rules, part 9530.6620, subpart 6, a placing
authority may authorize peer recovery support and treatment service coordination for a
person who scores a severity of one or more in dimension 4, 5, or 6, under Minnesota Rules,
part 9530.6622. Authorization for peer recovery support and treatment service coordination
under this subdivision does not need to be provided in conjunction with treatment services
under Minnesota Rules, part 9530.6622, subpart 4, 5, or 6.
new text end

Sec. 35.

Minnesota Statutes 2018, section 254B.05, subdivision 1, is amended to read:


Subdivision 1.

Licensure required.

(a) Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
substance use disorder treatment, extended care, transitional residence, or outpatient treatment
services, and are licensed by tribal government are eligible vendors.

(b) On July 1, 2018, or upon federal approval, whichever is later, a licensed professional
in private practice who meets the requirements of section 245G.11, subdivisions 1 and 4,
is an eligible vendor of a comprehensive assessment and assessment summary provided
according to section 245G.05, and treatment services provided according to sections 245G.06
and 245G.07, subdivision 1, paragraphs (a), clauses (1) to deleted text begin(5)deleted text endnew text begin (4)new text end, and (b); and subdivision
2.

(c) On July 1, 2018, or upon federal approval, whichever is later, a county is an eligible
vendor for a comprehensive assessment and assessment summary when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 4, and
completed according to the requirements of section 245G.05. A county is an eligible vendor
of care coordination services when provided by an individual who meets the staffing
credentials of section 245G.11, subdivisions 1 and 7, and provided according to the
requirements of section 245G.07, subdivision 1, new text beginparagraph (a), new text endclause deleted text begin(7)deleted text endnew text begin (5)new text end.

(d) On July 1, 2018, or upon federal approval, whichever is later, a recovery community
organization that meets certification requirements identified by the commissioner is an
eligible vendor of peer support services.

(e) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.

Sec. 36.

Minnesota Statutes 2018, 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) deleted text beginon July 1, 2018, or upon federal approval, whichever is later,deleted text end comprehensive
assessments provided according to sections 245.4863, paragraph (a), and 245G.05deleted text begin, and
Minnesota Rules, part 9530.6422
deleted text end;

(3) deleted text beginon July 1, 2018, or upon federal approval, whichever is later,deleted text end care coordination
services provided according to section 245G.07, subdivision 1, paragraph (a), clause deleted text begin(6)deleted text endnew text begin
(5)
new text end;

(4) deleted text beginon July 1, 2018, or upon federal approval, whichever is later,deleted text end peer recovery support
services provided according to section 245G.07, subdivision deleted text begin1, paragraph (a)deleted text endnew text begin 2new text end, clause deleted text begin(5)deleted text endnew text begin
(8)
new text end;

(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.

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

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

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

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

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

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

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

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

(2) culturally specific 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:

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

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

(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;

(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

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

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

(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;

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

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

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

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

(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.

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

(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. 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.

Sec. 37.

Minnesota Statutes 2018, 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 deleted text beginby the state's
medical review agent
deleted text end 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 qualified
mental health professional licensed as defined in section 245.4871, subdivision 27, clauses
(1) to (6).

(b) A mental health professional making a referral shall submit documentation to the
state's medical review agent containing all information necessary to determine medical
necessity, including a standard diagnostic assessment completed within 180 days of the
individual's admission. Documentation shall include evidence of family participation in the
individual's treatment planning and signed consent for services.

Sec. 38.

Minnesota Statutes 2018, section 256B.0941, subdivision 3, is amended to read:


Subd. 3.

Per diem rate.

(a) The commissioner shall establish a statewide per diem rate
for psychiatric residential treatment facility services for individuals 21 years of age or
younger. The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers. Payment must not be made to more than one entity for each
individual for services provided under this section on a given day. The commissioner shall
set rates prospectively for the annual rate period. The commissioner shall require providers
to submit annual cost reports on a uniform cost reporting form and shall use submitted cost
reports to inform the rate-setting process. The cost reporting shall be done according to
federal requirements for Medicare cost reports.

(b) The following are included in the rate:

(1) costs necessary for licensure and accreditation, meeting all staffing standards for
participation, meeting all service standards for participation, meeting all requirements for
active treatment, maintaining medical records, conducting utilization review, meeting
inspection of care, and discharge planning. The direct services costs must be determined
using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff
and service-related transportation; and

(2) payment for room and board provided by facilities meeting all accreditation and
licensing requirements for participation.

(c) A facility may submit a claim for payment outside of the per diem for professional
services arranged by and provided at the facility by an appropriately licensed professional
who is enrolled as a provider with Minnesota health care programs. Arranged services deleted text beginmust
be billed by the facility on a separate claim, and the facility shall be responsible for payment
to the provider
deleted text endnew text begin may be billed by either the facility or the licensed professionalnew text end. These services
must be included in the individual plan of care and are subject to prior authorization deleted text beginby the
state's medical review agent
deleted text end.

(d) Medicaid shall reimburse for concurrent services as approved by the commissioner
to support continuity of care and successful discharge from the facility. "Concurrent services"
means services provided by another entity or provider while the individual is admitted to a
psychiatric residential treatment facility. Payment for concurrent services may be limited
and these services are subject to prior authorization by the state's medical review agent.
Concurrent services may include targeted case management, assertive community treatment,
clinical care consultation, team consultation, and treatment planning.

(e) Payment rates under this subdivision shall not include the costs of providing the
following services:

(1) educational services;

(2) acute medical care or specialty services for other medical conditions;

(3) dental services; and

(4) pharmacy drug costs.

(f) For purposes of this section, "actual cost" means costs that are allowable, allocable,
reasonable, and consistent with federal reimbursement requirements in Code of Federal
Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of
Management and Budget Circular Number A-122, relating to nonprofit entities.

APPENDIX

Repealed Minnesota Statutes: 19-4395

256I.05 MONTHLY RATES.

Subd. 3.

Limits on rates.

When a room and board rate is used to pay for an individual's room and board, the rate payable to the residence must not exceed the rate paid by an individual not receiving a room and board rate under this chapter.