1.1 	A bill for an act
1.2 	relating to human services; modifying provisions governing certified community 
1.3 	behavioral health clinics;amending Minnesota Statutes 2018, sections 245.735, 
1.4 	subdivision 3; 256B.0625, subdivision 57, by adding a subdivision.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2018, section 245.735, subdivision 3, is amended to read:
1.7 		Subd. 3.Certified community behavioral health clinics. (a) The commissioner shall 
1.8 	establish a state certification process for certified community behavioral health clinics 
1.9 	(CCBHCs) to be eligible for the prospective payment system in paragraph (f). Entities that 
1.10 	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 serve meet the needs of the clinic's 
1.16 	patient population the clinic serves;
1.17 	(3) ensure that clinic services are available and accessible to patients individuals and 
1.18 	families of all ages and genders and that crisis management services are available 24 hours 
1.19 	per day;
1.20 	(4) establish fees for clinic services for nonmedical assistance patients clients using a 
1.21 	sliding fee scale that ensures that services to patients clients are not denied or limited due 
1.22 	to a patient's a client'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; patient-centered individual- and family-centered treatment planning; 
2.8 	outpatient mental health and substance use services; targeted case management; psychiatric 
2.9 	rehabilitation services; peer support and counselor services and family support services; 
2.10 	and intensive community-based mental health services, including mental health services 
2.11 	for members of the armed forces and veterans;
2.12 	(7) provide coordination of care across settings and providers to ensure seamless 
2.13 	transitions for patients clients across the full spectrum of health services, including acute, 
2.14 	chronic, and behavioral needs. Care coordination may be accomplished through partnerships 
2.15 	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) be certified to provide integrated treatment for co-occurring mental illness and 
2.26 	substance use disorders in adults or children under Minnesota Rules, chapter 9533, effective 
2.27 	July 1, 2017;
2.28 	(10) (9) comply with standards relating to mental health services in Minnesota Rules, 
2.29 	parts 9505.0370 to 9505.0372;
2.30 	(11) (10) be licensed to provide chemical dependency substance use disorder treatment 
2.31 	under chapter 245G;
2.32 	(12) (11) be certified to provide children's therapeutic services and supports under section 
2.33 	256B.0943;
3.1 	(13) (12) be certified to provide adult rehabilitative mental health services under section 
3.2 	256B.0623;
3.3 	(14) (13) be enrolled to provide mental health crisis response services under section 
3.4 	256B.0624;
3.5 	(15) (14) be enrolled to provide mental health targeted case management under section 
3.6 	256B.0625, subdivision 20;
3.7 	(16) (15) comply with standards relating to mental health case management in Minnesota 
3.8 	Rules, parts 9520.0900 to 9520.0926; and
3.9 	(17) (16) provide services that comply with the evidence-based practices described in 
3.10 	paragraph (e).; and
3.11 	(17) comply with standards relating to peer services under sections 256B.0615, 
3.12 	256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), if peer services are 
3.13 	provided.
3.14 	(b) If an entity is unable to provide one or more of the services listed in paragraph (a), 
3.15 	clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has 
3.16 	a current contract with another entity that has the required authority to provide that service 
3.17 	and that meets federal CCBHC criteria as a designated collaborating organization, or, to 
3.18 	the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral 
3.19 	arrangement. The CCBHC must meet federal requirements regarding the type and scope of 
3.20 	services to be provided directly by the CCBHC.
3.21 	(c) Notwithstanding any other law that requires a county contract or other form of county 
3.22 	approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets 
3.23 	CCBHC requirements may receive the prospective payment under paragraph (f) for those 
3.24 	services without a county contract or county approval. There is no county share when 
3.25 	medical assistance pays the CCBHC prospective payment. As part of the certification process 
3.26 	in paragraph (a), the commissioner shall require a letter of support from the CCBHC's host 
3.27 	county confirming that the CCBHC and the county or counties it serves have an ongoing 
3.28 	relationship to facilitate access and continuity of care, especially for individuals who are 
3.29 	uninsured or who may go on and off medical assistance.
3.30 	(d) When the standards listed in paragraph (a) or other applicable standards conflict or 
3.31 	address similar issues in duplicative or incompatible ways, the commissioner may grant 
3.32 	variances to state requirements if the variances do not conflict with federal requirements. 
3.33 	If standards overlap, the commissioner may substitute all or a part of a licensure or 
4.1 	certification that is substantially the same as another licensure or certification. The 
4.2 	commissioner shall consult with stakeholders, as described in subdivision 4, before granting 
4.3 	variances under this provision. For the CCBHC that is certified but not approved for 
4.4 	prospective payment under subdivision 5m, the commissioner may grant a variance under 
4.5 	this paragraph if the variance does not increase the state share of costs.
4.6 	(e) The commissioner shall issue a list of required evidence-based practices to be 
4.7 	delivered by CCBHCs, and may also provide a list of recommended evidence-based practices. 
4.8 	The commissioner may update the list to reflect advances in outcomes research and medical 
4.9 	services for persons living with mental illnesses or substance use disorders. The commissioner 
4.10 	shall take into consideration the adequacy of evidence to support the efficacy of the practice, 
4.11 	the quality of workforce available, and the current availability of the practice in the state. 
4.12 	At least 30 days before issuing the initial list and any revisions, the commissioner shall 
4.13 	provide stakeholders with an opportunity to comment.
4.14 	(f) The commissioner shall establish standards and methodologies for a prospective 
4.15 	payment system for medical assistance payments for services delivered by certified 
4.16 	community behavioral health clinics, in accordance with guidance issued by the Centers 
4.17 	for Medicare and Medicaid Services. During the operation of the demonstration project, 
4.18 	payments shall comply with federal requirements for an enhanced federal medical assistance 
4.19 	percentage. The commissioner may include quality bonus payment in the prospective 
4.20 	payment system based on federal criteria and on a clinic's provision of the evidence-based 
4.21 	practices in paragraph (e). The prospective payment system does not apply to MinnesotaCare. 
4.22 	Implementation of the prospective payment system is effective July 1, 2017, or upon federal 
4.23 	approval, whichever is later.
4.24 	(g) The commissioner shall seek federal approval to continue federal financial 
4.25 	participation in payment for CCBHC services after the federal demonstration period ends 
4.26 	for clinics that were certified as CCBHCs during the demonstration period and that continue 
4.27 	to meet the CCBHC certification standards in paragraph (a). Payment for CCBHC services 
4.28 	shall cease effective July 1, 2019, if continued federal financial participation for the payment 
4.29 	of CCBHC services cannot be obtained.
4.30 	(h) The commissioner may certify at least one CCBHC located in an urban area and at 
4.31 	least one CCBHC located in a rural area, as defined by federal criteria. To the extent allowed 
4.32 	by federal law, the commissioner may limit the number of certified clinics so that the 
4.33 	projected claims for certified clinics will not exceed the funds budgeted for this purpose. 
4.34 	The commissioner shall give preference to clinics that:
5.1 	(1) provide a comprehensive range of services and evidence-based practices for all age 
5.2 	groups, with services being fully coordinated and integrated; and
5.3 	(2) enhance the state's ability to meet the federal priorities to be selected as a CCBHC 
5.4 	demonstration state.
5.5 	(i) (f) The commissioner shall recertify CCBHCs at least every three years. The 
5.6 	commissioner shall establish a process for decertification and shall require corrective action, 
5.7 	medical assistance repayment, or decertification of a CCBHC that no longer meets the 
5.8 	requirements in this section or that fails to meet the standards provided by the commissioner 
5.9 	in the application and certification process.

5.10 	EFFECTIVE DATE. This section is effective July 1, 2019, or upon federal approval, 
5.11 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
5.12 	when federal approval is obtained.

5.13 	Sec. 2. Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision 
5.14 	to read:
5.15 		Subd. 5m.Certified community behavioral health clinic services. (a) Medical 
5.16 	assistance covers certified community behavioral health clinic (CCBHC) services that meet 
5.17 	the requirements of section 245.735, subdivision 3.
5.18 	(b) The commissioner shall establish standards and methodologies for a prospective 
5.19 	payment system for medical assistance payments for services delivered by a CCBHC, in 
5.20 	accordance with guidance issued by the Centers for Medicare and Medicaid Services. The 
5.21 	commissioner may include a quality bonus payment in the prospective payment system 
5.22 	based on federal criteria and on a CCBHC's provision of the evidence-based practices in 
5.23 	section 245.735, subdivision 3, paragraph (e). The prospective payment system does not 
5.24 	apply to MinnesotaCare.
5.25 	(c) To the extent allowed by federal law, the commissioner may limit the number of 
5.26 	CCBHCs for the prospective payment system in paragraph (b) to ensure that the projected 
5.27 	claims do not exceed the money appropriated for this purpose. The commissioner shall 
5.28 	apply the following priorities, in the order listed, to give preference to clinics that:
5.29 	(1) provide a comprehensive range of services and evidence-based practices for all age 
5.30 	groups, with services being fully coordinated and integrated;
5.31 	(2) are certified as CCBHCs during the federal CCBHC demonstration period;
6.1 	(3) receive CCBHC grants from the United States Department of Health and Human 
6.2 	Services; or
6.3 	(4) focus on serving individuals in tribal areas and other underserved communities.
6.4 	(d) Unless otherwise indicated in applicable federal requirements, the prospective payment 
6.5 	system must continue to be based on the federal instructions issued for the federal CCBHC 
6.6 	demonstration, except:
6.7 	(1) the commissioner shall rebase CCBHC rates at least every two years;
6.8 	(2) the commissioner shall provide for a 90-day appeals process of the rebasing;
6.9 	(3) the commissioner shall reimburse a CCBHC for allowable costs, including direct 
6.10 	patient care costs and patient-related support services. These costs include but are not limited 
6.11 	to the costs of:
6.12 	(i) acquisition, implementation, and maintenance of electronic health records and patient 
6.13 	management systems;
6.14 	(ii) care coordination;
6.15 	(iii) a new CCBHC service that is not incorporated in the baseline prospective payment 
6.16 	system rate, or a deletion of a CCBHC service that is incorporated in the baseline rate;
6.17 	(iv) a change in service due to amended regulatory requirements or rules;
6.18 	(v) a change in operating costs attributable to capital expenditures associated with a 
6.19 	modification of the services, including new or expanded service facilities, regulatory 
6.20 	compliance, or changes in technology or medical practices at the clinic;
6.21 	(vi) a change in types of services due to a change in applicable technology and medical 
6.22 	practice utilized by the clinic; and
6.23 	(vii) a change in the scope of a project approved by the federal Substance Abuse and 
6.24 	Mental Health Services Administration or the commissioner; and
6.25 	(4) the prospective payment rate under this section does not apply for services rendered 
6.26 	by CCBHCs to individuals who are dually eligible for Medicare and medical assistance 
6.27 	when Medicare is the primary payer for the service.

6.28 	EFFECTIVE DATE. This section is effective July 1, 2019, or upon federal approval, 
6.29 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
6.30 	when federal approval is obtained.

7.1 	Sec. 3. Minnesota Statutes 2018, section 256B.0625, subdivision 57, is amended to read:
7.2 		Subd. 57.Payment for Part B Medicare crossover claims. (a) Effective for services 
7.3 	provided on or after January 1, 2012, medical assistance payment for an enrollee's 
7.4 	cost-sharing associated with Medicare Part B is limited to an amount up to the medical 
7.5 	assistance total allowed, when the medical assistance rate exceeds the amount paid by 
7.6 	Medicare.
7.7 	(b) Excluded from this limitation are payments for mental health services and payments 
7.8 	for dialysis services provided to end-stage renal disease patients. The exclusion for mental 
7.9 	health services does not apply to payments for physician services provided by psychiatrists 
7.10 	and advanced practice nurses with a specialty in mental health.
7.11 	(c) Excluded from this limitation are payments to federally qualified health centers and,
7.12 	rural health clinics, and CCBHCs subject to the prospective payment system under 
7.13 	subdivision 5m.

7.14 	EFFECTIVE DATE. This section is effective July 1, 2019, or upon federal approval, 
7.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
7.16 	when federal approval is obtained.