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SF 4111

as introduced - 91st Legislature (2019 - 2020) Posted on 03/10/2020 08:44am

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 provisions governing certified community
behavioral health clinic payments; amending Minnesota Statutes 2019 Supplement,
sections 245.735, subdivision 3; 256B.0625, subdivision 5m.


Section 1.

Minnesota Statutes 2019 Supplement, section 245.735, subdivision 3, is amended
to read:

Subd. 3.

Certified community behavioral health clinics.

(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs). Entities that choose to be CCBHCs must:

(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;

(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;

(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;

(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;

(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;

(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization services; screening,
assessment, and diagnosis services, including risk assessments and level of care
determinations; person- and family-centered treatment planning; outpatient mental health
and substance use services; targeted case management; psychiatric rehabilitation services;
peer support and counselor services and family support services; and intensive
community-based mental health services, including mental health services for members of
the armed forces and veterans;

(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:

(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and

(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;

(8) be certified as mental health clinics under section 245.69, subdivision 2;

(9) comply with standards relating to mental health services in Minnesota Rules, parts
9505.0370 to 9505.0372, and section 256B.0671;

(10) be licensed to provide substance use disorder treatment under chapter 245G;

(11) be certified to provide children's therapeutic services and supports under section

(12) be certified to provide adult rehabilitative mental health services under section

(13) be enrolled to provide mental health crisis response services under sections
256B.0624 and 256B.0944;

(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;

(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;

(16) provide services that comply with the evidence-based practices described in
paragraph (e); and

(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.

(b) If an entity is unable to provide one or more of the services listed in paragraph (a),
clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has
a current contract with another entity that has the required authority to provide that service
and that meets federal CCBHC criteria as a designated collaborating organization, or, to
the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral
arrangement. The CCBHC must meet federal requirements regarding the type and scope of
services to be provided directly by the CCBHC.

(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m
, for those services without a county contract or county approval. deleted text beginThere is
no county share when medical assistance pays the CCBHC prospective payment.
deleted text end As part
of the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.

(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements.
If standards overlap, the commissioner may substitute all or a part of a licensure or
certification that is substantially the same as another licensure or certification. The
commissioner shall consult with stakeholders, as described in subdivision 4, before granting
variances under this provision. For the CCBHC that is certified but not approved for
prospective payment under section 256B.0625, subdivision 5m, the commissioner may
grant a variance under this paragraph if the variance does not increase the state share of

(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.

(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.

Sec. 2.

Minnesota Statutes 2019 Supplement, section 256B.0625, subdivision 5m, is
amended to read:

Subd. 5m.

Certified community behavioral health clinic services.

(a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.

(b) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by a CCBHC, in
accordance with guidance issued by the Centers for Medicare and Medicaid Services. The
commissioner shall include a quality bonus payment in the prospective payment system
based on federal text begin There is no county share when medical assistance pays the CCBHC
prospective payment.
new text end

deleted text begin (c) To the extent allowed by federal law, the commissioner may limit the number of
CCBHCs for the prospective payment system in paragraph (b) to ensure that the projected
claims do not exceed the money appropriated for this purpose. The commissioner shall
apply the following priorities, in the order listed, to give preference to clinics that:
deleted text end

deleted text begin (1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated;
deleted text end

deleted text begin (2) are certified as CCBHCs during the federal section 223 CCBHC demonstration
deleted text end

deleted text begin (3) receive CCBHC grants from the United States Department of Health and Human
Services; or
deleted text end

deleted text begin (4) focus on serving individuals in tribal areas and other underserved communities.
deleted text end

deleted text begin (d)deleted text endnew text begin (c)new text end Unless otherwise indicated in applicable federal requirements, the prospective
payment system must continue to be based on the federal instructions issued for the federal
section 223 CCBHC demonstration, except:

(1) the commissioner shall rebase CCBHC rates at least every three years;

(2) the commissioner shall provide for a 60-day appeals process of the rebasing;

(3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;

(4) the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;

(5) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments;

(6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services; deleted text beginand
deleted text end

(7) the prospective payment rate for each CCBHC shall be adjusted annually by the
Medicare Economic Index as defined for the federal section 223 CCBHC demonstrationdeleted text begin.deleted text endnew text begin;
new text end

new text begin (8) the commissioner shall seek federal approval for a CCBHC rate methodology that
allows for rate modifications based on changes in scope for an individual CCBHC, including
changes to the type, intensity, or duration of services. Upon federal approval, a CCBHC
may submit a change of scope request to the commissioner if the change in scope would
result in a change of 2.5 percent or more in the prospective payment system rate currently
received by the CCBHC. CCBHC change of scope requests must be according to a format
and timeline to be determined by the commissioner, in consultation with CCBHCs.
new text end

new text begin (d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the prospective payment rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received due to the provisions of this paragraph,
the commissioner must adjust the capitation rates paid to managed care plans and
county-based purchasing plans for that contract year to reflect the removal of this provision.
Contracts between managed care plans and county-based purchasing plans and providers
to whom this paragraph applies must allow recovery of payments from those providers if
capitation rates are adjusted in accordance with this paragraph. Payment recoveries must
not exceed the amount equal to any increase in rates that results from this provision. If
federal approval is not received at any time due to the provisions of this paragraph, this
paragraph will expire.
new text end