HF 1994

as introduced - 94th Legislature (2025 - 2026) Posted on 03/06/2025 02:41pm

A bill for an act
relating to human services; establishing payment rates for certain substance use
disorder treatment services; recodifying vendor eligibility for payments from the
behavioral health fund; amending Minnesota Statutes 2024, sections 254B.05,
subdivision 5, by adding subdivisions; 256B.761.

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

ARTICLE 1

SUBSTANCE USE DISORDER TREATMENT RATES

Section 1.

Minnesota Statutes 2024, section 254B.05, subdivision 5, is amended to read:

Subd. 5.

Rate requirements.

(a) new text begin Subject to the requirements of subdivisions 6 and 7,
new text end the commissioner shall establish rates for new text begin the following new text end substance use disorder new text begin treatment
new text end services deleted text begin and service enhancements deleted text end funded under this chapter deleted text begin . deleted text end new text begin :
new text end

deleted text begin (b) Eligible substance use disorder treatment services include:
deleted text end

(1) those licensed, as applicable, according to chapter 245G or applicable Tribal license
and provided according to the following ASAM levels of care:

(i) ASAM level 0.5 early intervention services provided according to section 254B.19,
subdivision 1, clause (1);

(ii) ASAM level 1.0 outpatient services provided according to section 254B.19,
subdivision 1, clause (2);

(iii) ASAM level 2.1 intensive outpatient services provided according to section 254B.19,
subdivision 1, clause (3);

(iv) ASAM level 2.5 partial hospitalization services provided according to section
254B.19, subdivision 1, clause (4);

(v) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5) deleted text begin . The commissioner shall use the
base payment rate of $79.84 per day for services provided under this item deleted text end ;

(vi) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5), at 15 or more hours of skilled
treatment services each week deleted text begin . The commissioner shall use the base payment rate of $166.13
per day for services provided under this item deleted text end ;

(vii) ASAM level 3.3 clinically managed population-specific high-intensity residential
services provided according to section 254B.19, subdivision 1, clause (6) deleted text begin . The commissioner
shall use the specified base payment rate of $224.06 per day for services provided under
this item deleted text end ; and

(viii) ASAM level 3.5 clinically managed high-intensity residential services provided
according to section 254B.19, subdivision 1, clause (7) deleted text begin . The commissioner shall use the
specified base payment rate of $224.06 per day for services provided under this item deleted text end ;

(2) comprehensive assessments provided according to section 254A.19, subdivision 3;

(3) treatment coordination services provided according to section 245G.07, subdivision
1, paragraph (a), clause (5);

(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);

(5) withdrawal management services provided according to chapter 245F;

(6) 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;

(7) substance use disorder treatment services with medications for opioid use disorder
provided in an opioid treatment program licensed according to sections 245G.01 to 245G.17
and 245G.22, or under an applicable Tribal license;

(8) medium-intensity residential treatment services that provide 15 hours of skilled
treatment services each week and are licensed according to sections 245G.01 to 245G.17
and 245G.21 or applicable Tribal license;

(9) 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;

(10) ASAM 3.5 clinically managed high-intensity residential services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable Tribal license, which
provide ASAM level of care 3.5 according to section 254B.19, subdivision 1, clause (7),
and are 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

(11) room and board facilities that meet the requirements of subdivision 1a.

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

(1) Programs that serve parents with their children new text begin are eligible for an enhanced payment
rate new text end 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) is licensed under chapter 245A and sections 245G.01 to 245G.19; 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 deleted text begin ; deleted text end new text begin .
new text end

new text begin In order to be eligible for a higher rate under this clause, a program that provides
arrangements for off-site child care must maintain current documentation at the substance
use disorder facility of the child care provider's current licensure to provide child care
services.
new text end

(2) Culturally specific or culturally responsive programs as defined in section 254B.01,
subdivision 4a deleted text begin ; deleted text end new text begin are eligible for an enhanced payment rate.
new text end

(3) Disability responsive programs as defined in section 254B.01, subdivision 4b deleted text begin ; deleted text end new text begin are
eligible for an enhanced payment rate.
new text end

(4) Programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to one hour per client per week new text begin are eligible for an enhanced
payment rate new text end if the medical needs of the client and the nature and provision of any medical
services provided are documented in the client file deleted text begin ; or deleted text end new text begin .
new text end

(5) Programs that offer services to individuals with co-occurring mental health and
substance use disorder problems new text begin are eligible for an enhanced payment rate new text end if:

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

(ii) the program employs a mental health professional as defined in section 245I.04,
subdivision 2;

(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 use disorder
and the interaction between the two; and

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

deleted text begin (d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the substance use disorder facility of the child care provider's current licensure to provide
child care services.
deleted text end

deleted text begin (e) deleted text end 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 deleted text begin paragraph (c), clause (5), deleted text end items (i) to (iv).

deleted text begin (f) deleted text end new text begin (c) new text end Substance use disorder services that are otherwise covered as direct face-to-face
services may be provided via telehealth as defined in section 256B.0625, subdivision 3b.
The use of telehealth to deliver services 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.

deleted text begin (g) deleted text end new text begin (d) new text end For the purpose of reimbursement under this section, substance use disorder
treatment services provided in a group setting without a group participant maximum or
maximum client to staff ratio under chapter 245G shall not exceed a client to staff ratio of
48 to one. At least one of the attending staff must meet the qualifications as established
under this chapter for the type of treatment service provided. A recovery peer may not be
included as part of the staff ratio.

deleted text begin (h) deleted text end new text begin (e) new text end Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.

deleted text begin (i) deleted text end new text begin (f) new text end Payment for substance use disorder services under this section must start from the
day of service initiation, when the comprehensive assessment is completed within the
required timelines.

deleted text begin (j) deleted text end new text begin (g) new text end A license holder that is unable to provide all residential treatment services because
a client missed services remains eligible to bill for the client's intensity level of services
under this paragraph if the license holder can document the reason the client missed services
and the interventions done to address the client's absence.

deleted text begin (k) deleted text end new text begin (h) new text end Hours in a treatment week may be reduced in observance of federally recognized
holidays.

deleted text begin (l) deleted text end new text begin (i) new text end Eligible vendors of peer recovery support services must:

(1) submit to a review by the commissioner of up to ten percent of all medical assistance
and behavioral health fund claims to determine the medical necessity of peer recovery
support services for entities billing for peer recovery support services individually and not
receiving a daily rate; and

(2) limit an individual client to 14 hours per week for peer recovery support services
from an individual provider of peer recovery support services.

deleted text begin (m) deleted text end new text begin (j) new text end Peer recovery support services not provided in accordance with section 254B.052
are subject to monetary recovery under section 256B.064 as money improperly paid.

Sec. 2.

Minnesota Statutes 2024, section 254B.05, is amended by adding a subdivision to
read:

new text begin Subd. 6. new text end

new text begin Base year payment rates. new text end

new text begin (a) Notwithstanding subdivision 5, paragraph (a),
effective January 1, 2026, the base payment rates in this section apply.
new text end

new text begin (b) The payment rate for individual counseling included in ASAM level 1.0 outpatient
services provided according to section 254B.19, subdivision 1, clause (2), is $140.27 per
unit.
new text end

new text begin (c) The payment rate for group counseling included in ASAM level 1.0 outpatient services
provided according to section 254B.19, subdivision 1, clause (2), is $42.97 per unit.
new text end

new text begin (d) The payment rate for individual counseling included in ASAM level 2.1 intensive
outpatient services provided according to section 254B.19, subdivision 1, clause (3), is
$140.27 per unit.
new text end

new text begin (e) The payment rate for group counseling included in ASAM level 2.1 intensive
outpatient services provided according to section 254B.19, subdivision 1, clause (3), is
$42.97 per unit.
new text end

new text begin (f) The payment rate for individual counseling included in ASAM level 2.5 partial
hospitalization services provided according to section 254B.19, subdivision 1, clause (4),
is $140.27 per unit.
new text end

new text begin (g) The payment rate for group counseling included in ASAM level 2.5 partial
hospitalization services provided according to section 254B.19, subdivision 1, clause (4),
is $42.97 per unit.
new text end

new text begin (h) The payment rate for ASAM level 3.1 clinically managed low-intensity residential
services provided according to section 254B.19, subdivision 1, clause (5), is $166.13 per
day for services.
new text end

new text begin (i) The payment rate for ASAM level 3.1 clinically managed low-intensity residential
services provided according to section 254B.19, subdivision 1, clause (5), at 15 or more
hours of skilled treatment services each week, is $216.90 per day for services.
new text end

new text begin (j) The payment rate for ASAM level 3.3 clinically managed population-specific
high-intensity residential services provided according to section 254B.19, subdivision 1,
clause (6), is $355.02 per day for services.
new text end

new text begin (k) The payment rate for ASAM level 3.5 clinically managed high-intensity residential
services provided according to section 254B.19, subdivision 1, clause (7), is $355.02 per
day for services.
new text end

new text begin (l) The payment rate for ASAM level 3.7 medically monitored withdrawal management
services provided according to section 254B.19, subdivision 1, clause (9), is $576.18 per
day for services.
new text end

new text begin (m) The payment rate for comprehensive assessments provided according to section
254A.19, subdivision 3, is $156.04.
new text end

new text begin (n) The payment rate for treatment coordination services provided according to section
245G.07, subdivision 1, paragraph (a), clause (5), is $37.13 per unit.
new text end

new text begin (o) The payment rate for peer recovery support services provided according to section
245G.07, subdivision 2, clause (8), is $28.43 per unit.
new text end

Sec. 3.

Minnesota Statutes 2024, section 254B.05, is amended by adding a subdivision to
read:

new text begin Subd. 7. new text end

new text begin Annual payment rate adjustments. new text end

new text begin Effective January 1, 2027, and annually
thereafter, the commissioner of human services must adjust the payment rates under
subdivision 6 according to the change from the midpoint of the previous rate year to the
midpoint of the rate year for which the rate is being determined using the Centers for
Medicare and Medicaid Services Medicare Economic Index as forecasted in the fourth
quarter of the calendar year before the rate year.
new text end

Sec. 4.

Minnesota Statutes 2024, section 256B.761, is amended to read:

256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.

(c) In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256K.10. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.

(d) Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

(e) Effective for services rendered on or after January 1, 2024, payment rates for
behavioral health services included in the rate analysis required by Laws 2021, First Special
Session chapter 7, article 17, section 18, except for adult day treatment services under section
256B.0671, subdivision 3; early intensive developmental and behavioral intervention services
under section 256B.0949; and substance use disorder services under chapter 254B, must be
increased by three percent from the rates in effect on December 31, 2023. Effective for
services rendered on or after January 1, 2025, payment rates for behavioral health services
included in the rate analysis required by Laws 2021, First Special Session chapter 7, article
17, section 18 deleted text begin ; deleted text end new text begin , and new text end early intensive developmental behavioral intervention services under
section 256B.0949 deleted text begin ; and substance use disorder services under chapter 254B, deleted text end must be annually
adjusted according to the change from the midpoint of the previous rate year to the midpoint
of the rate year for which the rate is being determined using the Centers for Medicare and
Medicaid Services Medicare Economic Index as forecasted in the fourth quarter of the
calendar year before the rate year. For payments made in accordance with this paragraph,
if and to the extent that the commissioner identifies that the state has received federal
financial participation for behavioral health services in excess of the amount allowed under
United States Code, title 42, section 447.321, the state shall repay the excess amount to the
Centers for Medicare and Medicaid Services with state money and maintain the full payment
rate under this paragraph. This paragraph does not apply to federally qualified health centers,
rural health centers, Indian health services, certified community behavioral health clinics,
cost-based rates, and rates that are negotiated with the county. This paragraph expires upon
legislative implementation of the new rate methodology resulting from the rate analysis
required by Laws 2021, First Special Session chapter 7, article 17, section 18.

(f) Effective January 1, 2024, the commissioner shall increase capitation payments made
to managed care plans and county-based purchasing plans to reflect the behavioral health
service rate increase provided in paragraph (e). Managed care and county-based purchasing
plans must use the capitation rate increase provided under this paragraph to increase payment
rates to behavioral health services providers. The commissioner must monitor the effect of
this rate increase on enrollee access to behavioral health services. If for any contract year
federal approval is not received for 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.

ARTICLE 2

RECODIFICATION OF SUBSTANCE USE DISORDER TREATMENT VENDOR
ELIGIBILITY AND CONFORMING CHANGES

Section 1. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes, in consultation with the House Research Department; the Office
of Senate Counsel, Research and Fiscal Analysis; and the Department of Human Services
shall make necessary cross-reference changes and remove statutory cross-references in
Minnesota Statutes to conform with the renumbering in this act. The revisor may make
technical and other necessary changes to sentence structure to preserve the meaning of the
text. The revisor may alter the coding in this act to incorporate statutory changes made by
other law in the 2025 regular legislative session or a special session. If a provision stricken
in this act is also amended in the 2025 regular legislative session or a special session by
other law, the revisor shall merge the amendment into the numbering, notwithstanding
Minnesota Statutes, section 645.30.
new text end

Sec. 2. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes shall renumber each provision of Minnesota Statutes listed in
column A as amended in this act to the number listed in column B. The revisor shall also
make necessary cross-reference changes consistent with the renumbering.
new text end

new text begin Column A new text end	new text begin Column B new text end
new text begin 254B.05, subdivision 1, paragraph (a) new text end	new text begin 254B.0501, subdivision 1 new text end
new text begin 254B.05, subdivision 1, paragraph (i) new text end	new text begin 254B.0501, subdivision 2 new text end
new text begin 254B.05, subdivision 4 new text end	new text begin 254B.0501, subdivision 3 new text end
new text begin 254B.05, subdivision 1, paragraph (b) new text end	new text begin 254B.0501, subdivision 4 new text end
new text begin 254B.05, subdivision 1, paragraph (c) new text end	new text begin 254B.0501, subdivision 5 new text end
new text begin 254B.05, subdivision 1, paragraph (d) new text end	new text begin 254B.0501, subdivision 6, paragraph (a) new text end
new text begin 254B.05, subdivision 1, paragraph (e) new text end	new text begin 254B.0501, subdivision 6, paragraph (b) new text end
new text begin 254B.05, subdivision 1, paragraph (f) new text end	new text begin 254B.0501, subdivision 6, paragraph (c) new text end
new text begin 254B.05, subdivision 1, paragraph (g) new text end	new text begin 254B.0501, subdivision 6, paragraph (d) new text end
new text begin 254B.05, subdivision 1, paragraph (h) new text end	new text begin 254B.0501, subdivision 7 new text end
new text begin 254B.05, subdivision 1b new text end	new text begin 254B.0501, subdivision 8 new text end
new text begin 254B.05, subdivision 2 new text end	new text begin 254B.0501, subdivision 9 new text end
new text begin 254B.05, subdivision 3 new text end	new text begin 254B.0501, subdivision 10 new text end
new text begin 254B.05, subdivision 1a, paragraph (a) new text end	new text begin 254B.0503, subdivision 1, paragraph (a) new text end
new text begin 254B.05, subdivision 1a, paragraph (c) new text end	new text begin 254B.0503, subdivision 1, paragraph (b) new text end
new text begin 254B.05, subdivision 1a, paragraph (d) new text end	new text begin 254B.0503, subdivision 1, paragraph (c) new text end
new text begin 254B.05, subdivision 1a, paragraph (e) new text end	new text begin 254B.0503, subdivision 1, paragraph (d) new text end
new text begin 254B.05, subdivision1a, paragraph (b) new text end	new text begin 254B.0503, subdivision 2, paragraph (a) new text end
new text begin 254B.05, subdivision 1a, paragraph (e) new text end	new text begin 254B.0503, subdivision 2, paragraph (b) new text end
new text begin 254B.05, subdivision 5, paragraph (a) new text end	new text begin 254B.0505, subdivision 1 new text end
new text begin 254B.05, subdivision 5, paragraph (c) new text end	new text begin 254B.0505, subdivision 2 new text end
new text begin 254B.05, subdivision 5, paragraph (d) new text end	new text begin 254B.0505, subdivision 3 new text end
new text begin 254B.05, subdivision 5, paragraph (e) new text end	new text begin 254B.0505, subdivision 4 new text end
new text begin 254B.05, subdivision 5, paragraph (f) new text end	new text begin 254B.0505, subdivision 5 new text end
new text begin 254B.05, subdivision 5, paragraph (g) new text end	new text begin 254B.0505, subdivision 6 new text end
new text begin 254B.05, subdivision 5, paragraph (h) new text end	new text begin 254B.0505, subdivision 7 new text end
new text begin 254B.05, subdivision 5, paragraph (i) new text end	new text begin 254B.0505, subdivision 8 new text end
new text begin 254B.05, subdivision 5, paragraph (b), first sentence new text end	new text begin 254B.0507, subdivision 1 new text end
new text begin 254B.05, subdivision 5, paragraph (b), clause (1), items (i) and (ii) new text end	new text begin 254B.0507, subdivision 2, paragraph (a) new text end
new text begin 254B.05, subdivision 5, paragraph (b), block left paragraph new text end	new text begin 254B.0507, subdivision 2, paragraph (b) new text end
new text begin 254B.05, subdivision 5, paragraph (b), clause (2) new text end	new text begin 254B.0507, subdivision 3 new text end
new text begin 254B.05, subdivision 5, paragraph (b), clause (3) new text end	new text begin 254B.0507, subdivision 4 new text end
new text begin 254B.05, subdivision 5, paragraph (b), clause (4) new text end	new text begin 254B.0507, subdivision 5 new text end
new text begin 254B.05, subdivision 5, paragraph (b), clause (5) new text end	new text begin 254B.0507, subdivision 6, paragraph (a) new text end
new text begin 254B.05, subdivision 5, paragraph (b), clause (5), block left paragraph new text end	new text begin 254B.0507, subdivision 6, paragraph (b) new text end
new text begin 254B.05, subdivision 6 new text end	new text begin 254B.0509, subdivision 1 new text end
new text begin 254B.05, subdivision 7 new text end	new text begin 254B.0509, subdivision 2 new text end
new text begin 254B.05, subdivision 1, paragraph (j) new text end	new text begin 254B.052, subdivision 4 new text end
new text begin 254B.05, subdivision 5, paragraph (j) new text end	new text begin 254B.052, subdivision 5 new text end