1.1 	A bill for an act
1.2 	relating to human services; modifying provisions governing certified community 
1.3 	behavioral health clinic payments;amending Minnesota Statutes 2019 Supplement, 
1.4 	sections 245.735, subdivision 3; 256B.0625, subdivision 5m.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2019 Supplement, section 245.735, subdivision 3, is amended 
1.7 	to read:
1.8 		Subd. 3.Certified community behavioral health clinics. (a) The commissioner shall 
1.9 	establish a state certification process for certified community behavioral health clinics 
1.10 	(CCBHCs). Entities that choose to be CCBHCs must:
1.11 	(1) comply with the CCBHC criteria published by the United States Department of 
1.12 	Health and Human Services;
1.13 	(2) employ or contract for clinic staff who have backgrounds in diverse disciplines, 
1.14 	including licensed mental health professionals and licensed alcohol and drug counselors, 
1.15 	and staff who are culturally and linguistically trained to meet the needs of the population 
1.16 	the clinic serves;
1.17 	(3) ensure that clinic services are available and accessible to individuals and families of 
1.18 	all ages and genders and that crisis management services are available 24 hours per day;
1.19 	(4) establish fees for clinic services for individuals who are not enrolled in medical 
1.20 	assistance using a sliding fee scale that ensures that services to patients are not denied or 
1.21 	limited due to an individual's inability to pay for services;
2.1 	(5) comply with quality assurance reporting requirements and other reporting 
2.2 	requirements, including any required reporting of encounter data, clinical outcomes data, 
2.3 	and quality data;
2.4 	(6) provide crisis mental health and substance use services, withdrawal management 
2.5 	services, emergency crisis intervention services, and stabilization services; screening, 
2.6 	assessment, and diagnosis services, including risk assessments and level of care 
2.7 	determinations; person- and family-centered treatment planning; outpatient mental health 
2.8 	and substance use services; targeted case management; psychiatric rehabilitation services; 
2.9 	peer support and counselor services and family support services; and intensive 
2.10 	community-based mental health services, including mental health services for members of 
2.11 	the armed forces and veterans;
2.12 	(7) provide coordination of care across settings and providers to ensure seamless 
2.13 	transitions for individuals being served across the full spectrum of health services, including 
2.14 	acute, chronic, and behavioral needs. Care coordination may be accomplished through 
2.15 	partnerships or formal contracts with:
2.16 	(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified 
2.17 	health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or 
2.18 	community-based mental health providers; and
2.19 	(ii) other community services, supports, and providers, including schools, child welfare 
2.20 	agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally 
2.21 	licensed health care and mental health facilities, urban Indian health clinics, Department of 
2.22 	Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals, 
2.23 	and hospital outpatient clinics;
2.24 	(8) be certified as mental health clinics under section 245.69, subdivision 2;
2.25 	(9) comply with standards relating to mental health services in Minnesota Rules, parts 
2.26 	9505.0370 to 9505.0372, and section 256B.0671;
2.27 	(10) be licensed to provide substance use disorder treatment under chapter 245G;
2.28 	(11) be certified to provide children's therapeutic services and supports under section 
2.29 	256B.0943;
2.30 	(12) be certified to provide adult rehabilitative mental health services under section 
2.31 	256B.0623;
2.32 	(13) be enrolled to provide mental health crisis response services under sections 
2.33 	256B.0624 and 256B.0944;
3.1 	(14) be enrolled to provide mental health targeted case management under section 
3.2 	256B.0625, subdivision 20;
3.3 	(15) comply with standards relating to mental health case management in Minnesota 
3.4 	Rules, parts 9520.0900 to 9520.0926;
3.5 	(16) provide services that comply with the evidence-based practices described in 
3.6 	paragraph (e); and
3.7 	(17) comply with standards relating to peer services under sections 256B.0615, 
3.8 	256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer 
3.9 	services are provided.
3.10 	(b) If an entity is unable to provide one or more of the services listed in paragraph (a), 
3.11 	clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has 
3.12 	a current contract with another entity that has the required authority to provide that service 
3.13 	and that meets federal CCBHC criteria as a designated collaborating organization, or, to 
3.14 	the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral 
3.15 	arrangement. The CCBHC must meet federal requirements regarding the type and scope of 
3.16 	services to be provided directly by the CCBHC.
3.17 	(c) Notwithstanding any other law that requires a county contract or other form of county 
3.18 	approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets 
3.19 	CCBHC requirements may receive the prospective payment under section 256B.0625, 
3.20 	subdivision 5m, for those services without a county contract or county approval. There is 
3.21 	no county share when medical assistance pays the CCBHC prospective payment. As part 
3.22 	of the certification process in paragraph (a), the commissioner shall require a letter of support 
3.23 	from the CCBHC's host county confirming that the CCBHC and the county or counties it 
3.24 	serves have an ongoing relationship to facilitate access and continuity of care, especially 
3.25 	for individuals who are uninsured or who may go on and off medical assistance.
3.26 	(d) When the standards listed in paragraph (a) or other applicable standards conflict or 
3.27 	address similar issues in duplicative or incompatible ways, the commissioner may grant 
3.28 	variances to state requirements if the variances do not conflict with federal requirements. 
3.29 	If standards overlap, the commissioner may substitute all or a part of a licensure or 
3.30 	certification that is substantially the same as another licensure or certification. The 
3.31 	commissioner shall consult with stakeholders, as described in subdivision 4, before granting 
3.32 	variances under this provision. For the CCBHC that is certified but not approved for 
3.33 	prospective payment under section 256B.0625, subdivision 5m, the commissioner may 
4.1 	grant a variance under this paragraph if the variance does not increase the state share of 
4.2 	costs.
4.3 	(e) The commissioner shall issue a list of required evidence-based practices to be 
4.4 	delivered by CCBHCs, and may also provide a list of recommended evidence-based practices. 
4.5 	The commissioner may update the list to reflect advances in outcomes research and medical 
4.6 	services for persons living with mental illnesses or substance use disorders. The commissioner 
4.7 	shall take into consideration the adequacy of evidence to support the efficacy of the practice, 
4.8 	the quality of workforce available, and the current availability of the practice in the state. 
4.9 	At least 30 days before issuing the initial list and any revisions, the commissioner shall 
4.10 	provide stakeholders with an opportunity to comment.
4.11 	(f) The commissioner shall recertify CCBHCs at least every three years. The 
4.12 	commissioner shall establish a process for decertification and shall require corrective action, 
4.13 	medical assistance repayment, or decertification of a CCBHC that no longer meets the 
4.14 	requirements in this section or that fails to meet the standards provided by the commissioner 
4.15 	in the application and certification process.

4.16 	Sec. 2. Minnesota Statutes 2019 Supplement, section 256B.0625, subdivision 5m, is 
4.17 	amended to read:
4.18 		Subd. 5m.Certified community behavioral health clinic services. (a) Medical 
4.19 	assistance covers certified community behavioral health clinic (CCBHC) services that meet 
4.20 	the requirements of section 245.735, subdivision 3.
4.21 	(b) The commissioner shall establish standards and methodologies for a prospective 
4.22 	payment system for medical assistance payments for services delivered by a CCBHC, in 
4.23 	accordance with guidance issued by the Centers for Medicare and Medicaid Services. The 
4.24 	commissioner shall include a quality bonus payment in the prospective payment system 
4.25 	based on federal criteria. There is no county share when medical assistance pays the CCBHC 
4.26 	prospective payment.
4.27 	(c) To the extent allowed by federal law, the commissioner may limit the number of 
4.28 	CCBHCs for the prospective payment system in paragraph (b) to ensure that the projected 
4.29 	claims do not exceed the money appropriated for this purpose. The commissioner shall 
4.30 	apply the following priorities, in the order listed, to give preference to clinics that:
4.31 	(1) provide a comprehensive range of services and evidence-based practices for all age 
4.32 	groups, with services being fully coordinated and integrated;
5.1 	(2) are certified as CCBHCs during the federal section 223 CCBHC demonstration 
5.2 	period;
5.3 	(3) receive CCBHC grants from the United States Department of Health and Human 
5.4 	Services; or
5.5 	(4) focus on serving individuals in tribal areas and other underserved communities.
5.6 	(d) (c) Unless otherwise indicated in applicable federal requirements, the prospective 
5.7 	payment system must continue to be based on the federal instructions issued for the federal 
5.8 	section 223 CCBHC demonstration, except:
5.9 	(1) the commissioner shall rebase CCBHC rates at least every three years;
5.10 	(2) the commissioner shall provide for a 60-day appeals process of the rebasing;
5.11 	(3) the prohibition against inclusion of new facilities in the demonstration does not apply 
5.12 	after the demonstration ends;
5.13 	(4) the prospective payment rate under this section does not apply to services rendered 
5.14 	by CCBHCs to individuals who are dually eligible for Medicare and medical assistance 
5.15 	when Medicare is the primary payer for the service. An entity that receives a prospective 
5.16 	payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;
5.17 	(5) payments for CCBHC services to individuals enrolled in managed care shall be 
5.18 	coordinated with the state's phase-out of CCBHC wrap payments;
5.19 	(6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be 
5.20 	based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner 
5.21 	shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for 
5.22 	changes in the scope of services; and
5.23 	(7) the prospective payment rate for each CCBHC shall be adjusted annually by the 
5.24 	Medicare Economic Index as defined for the federal section 223 CCBHC demonstration.; 
5.25 	and
5.26 	(8) the commissioner shall seek federal approval for a CCBHC rate methodology that 
5.27 	allows for rate modifications based on changes in scope for an individual CCBHC, including 
5.28 	changes to the type, intensity, or duration of services. Upon federal approval, a CCBHC 
5.29 	may submit a change of scope request to the commissioner if the change in scope would 
5.30 	result in a change of 2.5 percent or more in the prospective payment system rate currently 
5.31 	received by the CCBHC. CCBHC change of scope requests must be according to a format 
5.32 	and timeline to be determined by the commissioner, in consultation with CCBHCs.
6.1 	(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC 
6.2 	providers at the prospective payment rate. The commissioner shall monitor the effect of 
6.3 	this requirement on the rate of access to the services delivered by CCBHC providers. If, for 
6.4 	any contract year, federal approval is not received due to the provisions of this paragraph, 
6.5 	the commissioner must adjust the capitation rates paid to managed care plans and 
6.6 	county-based purchasing plans for that contract year to reflect the removal of this provision. 
6.7 	Contracts between managed care plans and county-based purchasing plans and providers 
6.8 	to whom this paragraph applies must allow recovery of payments from those providers if 
6.9 	capitation rates are adjusted in accordance with this paragraph. Payment recoveries must 
6.10 	not exceed the amount equal to any increase in rates that results from this provision. If 
6.11 	federal approval is not received at any time due to the provisions of this paragraph, this 
6.12 	paragraph will expire.