HF 2032

as introduced - 94th Legislature (2025 - 2026) Posted on 03/11/2025 12:14pm

A bill for an act
relating to behavioral health; establishing mental health case management and
community support services for persons with a complex post-traumatic stress
disorder; amending Minnesota Statutes 2024, sections 245.462, subdivision 20;
245.467, subdivision 4; 245.4711, subdivisions 1, 4; 245.4712, subdivisions 1, 3;
256B.0625, subdivision 20.

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

Section 1.

Minnesota Statutes 2024, section 245.462, subdivision 20, is amended to read:

Subd. 20.

Mental illness.

(a) "Mental illness" means an organic disorder of the brain or
a clinically significant disorder of thought, mood, perception, orientation, memory, or
behavior that is detailed in a diagnostic codes list published by the commissioner, and that
seriously limits a person's capacity to function in primary aspects of daily living such as
personal relations, living arrangements, work, and recreation.

(b) An "adult with acute mental illness" means an adult who has a mental illness that is
serious enough to require prompt intervention.

(c) For purposes of case management and community support services, a "person with
serious and persistent mental illness" means an adult who has a mental illness and meets at
least one of the following criteria:

(1) the adult has undergone two or more episodes of inpatient care for a mental illness
within the preceding 24 months;

(2) the adult has experienced a continuous psychiatric hospitalization or residential
treatment exceeding six months' duration within the preceding 12 months;

(3) the adult has been treated by a crisis team two or more times within the preceding
24 months;

(4) the adult:

(i) has a diagnosis of schizophrenia, bipolar disorder, major depression, schizoaffective
disorder, or borderline personality disorder;

(ii) indicates a significant impairment in functioning; and

(iii) has a written opinion from a mental health professional, in the last three years,
stating that the adult is reasonably likely to have future episodes requiring inpatient or
residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
management or community support services are provided;

(5) the adult has, in the last three years, been committed by a court as a person who is
mentally ill under chapter 253B, or the adult's commitment has been stayed or continued;

(6) the adult (i) was eligible under clauses (1) to (5), but the specified time period has
expired or the adult was eligible as a child under section 245.4871, subdivision 6; and (ii)
has a written opinion from a mental health professional, in the last three years, stating that
the adult is reasonably likely to have future episodes requiring inpatient or residential
treatment, of a frequency described in clause (1) or (2), unless ongoing case management
or community support services are provided; or

(7) the adult was eligible as a child under section 245.4871, subdivision 6, and is age
21 or younger.

new text begin (d) For purposes of case management and community support services, a person with
"a complex post-traumatic stress disorder" or "C-PTSD" means an adult who has a mental
illness and meets the following criteria:
new text end

new text begin (1) the adult has PTSD symptoms that significantly interfere with daily functioning
related to intergenerational trauma, racial trauma, or unresolved historical grief; and
new text end

new text begin (2) the adult has a written opinion from a mental health professional that includes
documentation of:
new text end

new text begin (i) culturally sensitive assessments or screenings and identification of intergenerational,
racial, or historical trauma;
new text end

new text begin (ii) significant impairment in functioning due to the PTSD symptoms that meet C-PTSD
condition eligibility; and
new text end

new text begin (iii) increasing concerns within the last three years to indicate that the adult is at a
reasonable likelihood of experiencing significant episodes of PTSD with increased frequency,
impacting daily functioning unless mitigated by targeted case management or community
support services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2024, section 245.467, subdivision 4, is amended to read:

Subd. 4.

Referral for case management.

Each provider of emergency services, day
treatment services, outpatient treatment, community support services, residential treatment,
acute care hospital inpatient treatment, or regional treatment center inpatient treatment must
inform each of its clients with serious and persistent mental illness new text begin or a complex
post-traumatic stress disorder new text end of the availability and potential benefits to the client of case
management. If the client consents, the provider must refer the client by notifying the county
employee designated by the county board to coordinate case management activities of the
client's name and address and by informing the client of whom to contact to request case
management. The provider must document compliance with this subdivision in the client's
record.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2024, section 245.4711, subdivision 1, is amended to read:

Subdivision 1.

Availability of case management services.

(a) deleted text begin By January 1, 1989, deleted text end The
county board shall provide case management services for all adults with serious and persistent
mental illness new text begin or a complex post-traumatic stress disorder new text end who are residents of the county
and who request or consent to the services and to each adult for whom the court appoints a
case manager. Staffing ratios must be sufficient to serve the needs of the clients. The case
manager must meet the requirements in section 245.462, subdivision 4.

(b) Case management services provided to adults with serious and persistent mental
illness new text begin or a complex post-traumatic stress disorder new text end eligible for medical assistance must be
billed to the medical assistance program under sections 256B.02, subdivision 8, and
256B.0625.

(c) Case management services are eligible for reimbursement under the medical assistance
program. Costs associated with mentoring, supervision, and continuing education may be
included in the reimbursement rate methodology used for case management services under
the medical assistance program.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2024, section 245.4711, subdivision 4, is amended to read:

Subd. 4.

Individual community support plan.

(a) The case manager must develop an
individual community support plan for each adult that incorporates the client's individual
treatment plan. The individual treatment plan may not be a substitute for the development
of an individual community support plan. The individual community support plan must be
developed within 30 days of client intake and reviewed at least every 180 days after it is
developed, unless the case manager receives a written request from the client or the client's
family for a review of the plan every 90 days after it is developed. The case manager is
responsible for developing the individual community support plan based on a diagnostic
assessment and a functional assessment and for implementing and monitoring the delivery
of services according to the individual community support plan. To the extent possible, the
adult with serious and persistent mental illness new text begin or a complex post-traumatic stress disorder new text end ,
the person's family, advocates, service providers, and significant others must be involved
in all phases of development and implementation of the individual community support plan.

(b) The client's individual community support plan must state:

(1) the goals of each service;

(2) the activities for accomplishing each goal;

(3) a schedule for each activity; and

(4) the frequency of face-to-face contacts by the case manager, as appropriate to client
need and the implementation of the individual community support plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2024, section 245.4712, subdivision 1, is amended to read:

Subdivision 1.

Availability of community support services.

(a) County boards must
provide or contract for sufficient community support services within the county to meet the
needs of adults with serious and persistent mental illness new text begin or a complex post-traumatic stress
disorder new text end who are residents of the county. Adults may be required to pay a fee according to
section 245.481. The community support services program must be designed to improve
the ability of adults with serious and persistent mental illness new text begin or a complex post-traumatic
stress disorder new text end to:

(1) find and maintain competitive employment;

(2) handle basic activities of daily living;

(3) participate in leisure time activities;

(4) set goals and plans; and

(5) obtain and maintain appropriate living arrangements.

The community support services program must also be designed to reduce the need for
and use of more intensive, costly, or restrictive placements both in number of admissions
and length of stay.

(b) Community support services are those services that are supportive in nature and not
necessarily treatment oriented, and include:

(1) conducting outreach activities such as home visits, health and wellness checks, and
problem solving;

(2) connecting people to resources to meet their basic needs;

(3) finding, securing, and supporting people in their housing;

(4) attaining and maintaining health insurance benefits;

(5) assisting with job applications, finding and maintaining employment, and securing
a stable financial situation;

(6) fostering social support, including support groups, mentoring, peer support, and other
efforts to prevent isolation and promote recovery; and

(7) educating about mental illness, treatment, and recovery.

(c) Community support services shall use all available funding streams. The county shall
maintain the level of expenditures for this program, as required under section 245.4835.
County boards must continue to provide funds for those services not covered by other
funding streams and to maintain an infrastructure to carry out these services. The county is
encouraged to fund evidence-based practices such as Individual Placement and Supported
Employment and Illness Management and Recovery.

(d) The commissioner shall collect data on community support services programs,
including, but not limited to, demographic information such as age, sex, race, the number
of people served, and information related to housing, employment, hospitalization, symptoms,
and satisfaction with services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 6.

Minnesota Statutes 2024, section 245.4712, subdivision 3, is amended to read:

Subd. 3.

Benefits assistance.

The county board must offer to help adults with serious
and persistent mental illness new text begin or a complex post-traumatic stress disorder new text end in applying for
state and federal benefits, including Supplemental Security Income, medical assistance,
Medicare, general assistance, and Minnesota supplemental aid. The help must be offered
as part of the community support program available to adults with serious and persistent
mental illness new text begin or a complex post-traumatic stress disorder new text end for whom the county is financially
responsible and who may qualify for these benefits.

Sec. 7.

Minnesota Statutes 2024, section 256B.0625, subdivision 20, is amended to read:

Subd. 20.

Mental health case management.

(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness new text begin , persons with a complex post-traumatic stress disorder, new text end and
children with severe emotional disturbance. Services provided under this section must meet
the relevant standards in sections 245.461 to 245.4887, the Comprehensive Adult and
Children's Mental Health Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and
9505.0322, excluding subpart 10.

(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.

(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact either in person or by interactive
video that meets the requirements of subdivision 20b with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:

(1) at least a face-to-face contact with the adult or the adult's legal representative either
in person or by interactive video that meets the requirements of subdivision 20b; or

(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact either in person or by interactive video that meets the
requirements of subdivision 20b with the adult or the adult's legal representative within the
preceding two months.

(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.

(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.

(f) Payment for mental health case management provided by vendors who contract with
a county must be calculated in accordance with section 256B.076, subdivision 2. Payment
for mental health case management provided by vendors who contract with a Tribe must
be based on a monthly rate negotiated by the Tribe. The rate must not exceed the rate charged
by the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the team shall determine how to distribute the rate among its members.
No reimbursement received by contracted vendors shall be returned to the county or tribe,
except to reimburse the county or tribe for advance funding provided by the county or tribe
to the vendor.

(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.

(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.

(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.

(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.

(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (n). The repayment is limited to:

(1) the costs of developing and implementing this section; and

(2) programming the information systems.

(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.

(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.

(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:

(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or

(2) the limits and conditions which apply to federal Medicaid funding for this service.

(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.

(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end