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Key: (1) language to be deleted (2) new language

CHAPTER 167--S.F.No. 1504
An act
relating to human services; amending mental health provisions; changing
medical assistance reimbursement and eligibility; changing provider qualification
and training requirements; amending mental health behavioral aide services;
changing special contracts with bordering states; amending Minnesota Statutes
2008, sections 148C.11, subdivision 1; 245.4835, subdivisions 1, 2; 245.4871,
subdivision 26; 245.4885, subdivision 1; 245.50, subdivision 5; 256B.0615,
subdivisions 1, 3; 256B.0622, subdivision 8, by adding a subdivision;
256B.0623, subdivision 5; 256B.0624, subdivision 8; 256B.0625, subdivision
49; 256B.0943, subdivisions 1, 2, 4, 5, 6, 7, 9; 256B.0944, subdivision 5.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

    Section 1. Minnesota Statutes 2008, section 148C.11, subdivision 1, is amended to read:
    Subdivision 1. Other professionals. (a) Nothing in this chapter prevents members
of other professions or occupations from performing functions for which they are qualified
or licensed. This exception includes, but is not limited to: licensed physicians; registered
nurses; licensed practical nurses; licensed psychological practitioners; members of
the clergy; American Indian medicine men and women; licensed attorneys; probation
officers; licensed marriage and family therapists; licensed social workers; social workers
employed by city, county, or state agencies; licensed professional counselors; licensed
school counselors; registered occupational therapists or occupational therapy assistants;
city, county, or state employees when providing assessments or case management under
Minnesota Rules, chapter 9530; and until July 1, 2009, individuals providing integrated
dual-diagnosis treatment in adult mental health rehabilitative programs certified by the
Department of Human Services under section 256B.0622 or 256B.0623.
    (b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.
    (c) Any person who is exempt under this subdivision but who elects to obtain a
license under this chapter is subject to this chapter to the same extent as other licensees.
The board shall issue a license without examination to an applicant who is licensed or
registered in a profession identified in paragraph (a) if the applicant:
    (1) shows evidence of current licensure or registration; and
    (2) has submitted to the board a plan for supervision during the first 2,000 hours of
professional practice or has submitted proof of supervised professional practice that is
acceptable to the board.
    (d) Any person who is exempt from licensure under this section must not use a
title incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold themselves out to the public by any title or description
stating or implying that they are engaged in the practice of alcohol and drug counseling,
or that they are licensed to engage in the practice of alcohol and drug counseling unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the
practice of alcohol and drug counseling are not exempt from the board's jurisdiction
solely by the use of one of the above titles.

    Sec. 2. Minnesota Statutes 2008, section 245.4835, subdivision 1, is amended to read:
    Subdivision 1. Required expenditures. (a) Counties must maintain a level of
expenditures for mental health services under sections 245.461 to 245.484 and 245.487 to
245.4889 so that each year's county expenditures are at least equal to that county's average
expenditures for those services for calendar years 2004 and 2005. The commissioner will
adjust each county's base level for minimum expenditures in each year by the amount of
any increase or decrease in that county's state grants or other noncounty revenues for
mental health services under sections 245.461 to 245.484 and 245.487 to 245.4889.
(b) In order to simplify administration and improve budgeting predictability, the
commissioner:
(1) shall use each county's actual prior year revenues to adjust the county's minimum
required expenditures for the coming year;
(2) may use more current information regarding major changes in revenues if the
change is known early enough to allow counties time to adjust their budgets;
(3) shall allocate each county's revenues proportionally across applicable
expenditures;
(4) shall adjust each county's base to allow for major changes in state or federal
block grants or other revenues that can be used for mental health services, but are not
dedicated to mental health; in this case, the commissioner shall calculate the mental health
share of total county expenditures that were eligible to be funded from that revenue
source in the base year, and use that mental health share to allocate the change in those
revenues to mental health. This clause applies to changes in revenues that are beyond
the county's control; and
(5) may adjust a county's base if the county's population is substantially declining
and the county's per capita mental health expenditures are substantially higher than the
state average, and the commissioner has determined that mental health services in that
county would not be negatively impacted.
(c) Paragraph (b), clause (4) expires December 31, 2011.

    Sec. 3. Minnesota Statutes 2008, section 245.4835, subdivision 2, is amended to read:
    Subd. 2. Failure to maintain expenditures. (a) If a county does not comply with
subdivision 1, the commissioner shall require the county to develop a corrective action plan
according to a format and timeline established by the commissioner. If the commissioner
determines that a county has not developed an acceptable corrective action plan within
the required timeline, or that the county is not in compliance with an approved corrective
action plan, the protections provided to that county under section 245.485 do not apply.
(b) The commissioner shall consider the following factors to determine whether to
approve a county's corrective action plan:
(1) the degree to which a county is maximizing revenues for mental health services
from noncounty sources;
(2) the degree to which a county is expanding use of alternative services that meet
mental health needs, but do not count as mental health services within existing reporting
systems. If approved by the commissioner, the alternative services must be included in the
county's base as well as subsequent years. The commissioner's approval for alternative
services must be based on the following criteria:
(i) the service must be provided to children with emotional disturbance or adults
with mental illness;
(ii) the services must be based on an individual treatment plan or individual
community support plan as defined in the Comprehensive Mental Health Act; and
(iii) the services must be supervised by a mental health professional and provided
by staff who meet the staff qualifications defined in sections 256B.0943, subdivision 7,
and 256B.0622, subdivision 5.
(c) Additional county expenditures to make up for the prior year's underspending
may be spread out over a two-year period.

    Sec. 4. Minnesota Statutes 2008, section 245.4871, subdivision 26, is amended to read:
    Subd. 26. Mental health practitioner. "Mental health practitioner" means a person
providing services to children with emotional disturbances. A mental health practitioner
must have training and experience in working with children. A mental health practitioner
must be qualified in at least one of the following ways:
(1) holds a bachelor's degree in one of the behavioral sciences or related fields from
an accredited college or university and:
(i) has at least 2,000 hours of supervised experience in the delivery of mental health
services to children with emotional disturbances; or
(ii) is fluent in the non-English language of the ethnic group to which at least 50
percent of the practitioner's clients belong, completes 40 hours of training in the delivery
of services to children with emotional disturbances, and receives clinical supervision from
a mental health professional at least once a week until the requirement of 2,000 hours
of supervised experience is met;
(2) has at least 6,000 hours of supervised experience in the delivery of mental
health services to children with emotional disturbances; hours worked as a mental health
behavioral aide I or II under section 256B.0943, subdivision 7, may be included in the
6,000 hours of experience;
(3) is a graduate student in one of the behavioral sciences or related fields and is
formally assigned by an accredited college or university to an agency or facility for
clinical training; or
(4) holds a master's or other graduate degree in one of the behavioral sciences or
related fields from an accredited college or university and has less than 4,000 hours
post-master's experience in the treatment of emotional disturbance.

    Sec. 5. Minnesota Statutes 2008, section 245.4885, subdivision 1, is amended to read:
    Subdivision 1. Admission criteria. The county board shall, prior to admission,
except in the case of emergency admission, determine the needed level of care for all
children referred for treatment of severe emotional disturbance in a treatment foster care
setting, residential treatment facility, or informally admitted to a regional treatment center
if public funds are used to pay for the services. The county board shall also determine the
needed level of care for all children admitted to an acute care hospital for treatment of
severe emotional disturbance if public funds other than reimbursement under chapters
256B and 256D are used to pay for the services. The level of care determination shall
determine whether the proposed treatment:
(1) is necessary;
(2) is appropriate to the child's individual treatment needs;
(3) cannot be effectively provided in the child's home; and
(4) provides a length of stay as short as possible consistent with the individual
child's need.
When a level of care determination is conducted, the county board may not
determine that referral or admission to a treatment foster care setting, or residential
treatment facility, or acute care hospital is not appropriate solely because services were
not first provided to the child in a less restrictive setting and the child failed to make
progress toward or meet treatment goals in the less restrictive setting. The level of care
determination must be based on a diagnostic assessment that includes a functional
assessment which evaluates family, school, and community living situations; and an
assessment of the child's need for care out of the home using a validated tool which
assesses a child's functional status and assigns an appropriate level of care. The validated
tool must be approved by the commissioner of human services. If a diagnostic assessment
including a functional assessment has been completed by a mental health professional
within the past 180 days, a new diagnostic assessment need not be completed unless in the
opinion of the current treating mental health professional the child's mental health status
has changed markedly since the assessment was completed. The child's parent shall be
notified if an assessment will not be completed and of the reasons. A copy of the notice
shall be placed in the child's file. Recommendations developed as part of the level of care
determination process shall include specific community services needed by the child and,
if appropriate, the child's family, and shall indicate whether or not these services are
available and accessible to the child and family.
During the level of care determination process, the child, child's family, or child's
legal representative, as appropriate, must be informed of the child's eligibility for case
management services and family community support services and that an individual
family community support plan is being developed by the case manager, if assigned.
The level of care determination shall comply with section 260C.212. Wherever
possible, the parent shall be consulted in the process, unless clinically inappropriate.
The level of care determination, and placement decision, and recommendations for
mental health services must be documented in the child's record.
An alternate review process may be approved by the commissioner if the county
board demonstrates that an alternate review process has been established by the county
board and the times of review, persons responsible for the review, and review criteria are
comparable to the standards in clauses (1) to (4).

    Sec. 6. Minnesota Statutes 2008, section 245.50, subdivision 5, is amended to read:
    Subd. 5. Special contracts; bordering states. (a) An individual who is detained,
committed, or placed on an involuntary basis under chapter 253B may be confined or
treated in a bordering state pursuant to a contract under this section. An individual who is
detained, committed, or placed on an involuntary basis under the civil law of a bordering
state may be confined or treated in Minnesota pursuant to a contract under this section. A
peace or health officer who is acting under the authority of the sending state may transport
an individual to a receiving agency that provides services pursuant to a contract under
this section and may transport the individual back to the sending state under the laws
of the sending state. Court orders valid under the law of the sending state are granted
recognition and reciprocity in the receiving state for individuals covered by a contract
under this section to the extent that the court orders relate to confinement for treatment
or care of mental illness or chemical dependency. Such treatment or care may address
other conditions that may be co-occurring with the mental illness or chemical dependency.
These court orders are not subject to legal challenge in the courts of the receiving state.
Individuals who are detained, committed, or placed under the law of a sending state and
who are transferred to a receiving state under this section continue to be in the legal
custody of the authority responsible for them under the law of the sending state. Except
in emergencies, those individuals may not be transferred, removed, or furloughed from
a receiving agency without the specific approval of the authority responsible for them
under the law of the sending state.
    (b) While in the receiving state pursuant to a contract under this section, an
individual shall be subject to the sending state's laws and rules relating to length of
confinement, reexaminations, and extensions of confinement. No individual may be sent
to another state pursuant to a contract under this section until the receiving state has
enacted a law recognizing the validity and applicability of this section.
    (c) If an individual receiving services pursuant to a contract under this section leaves
the receiving agency without permission and the individual is subject to involuntary
confinement under the law of the sending state, the receiving agency shall use all
reasonable means to return the individual to the receiving agency. The receiving agency
shall immediately report the absence to the sending agency. The receiving state has the
primary responsibility for, and the authority to direct, the return of these individuals
within its borders and is liable for the cost of the action to the extent that it would be
liable for costs of its own resident.
    (d) Responsibility for payment for the cost of care remains with the sending agency.
    (e) This subdivision also applies to county contracts under subdivision 2 which
include emergency care and treatment provided to a county resident in a bordering state.
    (f) If a Minnesota resident is admitted to a facility in a bordering state under this
chapter, a physician, licensed psychologist who has a doctoral degree in psychology, or
an advance practice registered nurse certified in mental health, who is licensed in the
bordering state, may act as an examiner under sections 253B.07, 253B.08, 253B.092,
253B.12, and 253B.17 subject to the same requirements and limitations in section
253B.02, subdivision 7. Such examiner may initiate an emergency hold under section
253B.05 on a Minnesota resident who is in a hospital that is under contract with a
Minnesota governmental entity under this section provided the resident, in the opinion of
the examiner, meets the criteria in section 253B.05.

    Sec. 7. Minnesota Statutes 2008, section 256B.0615, subdivision 1, is amended to read:
    Subdivision 1. Scope. Medical assistance covers mental health certified peers
specialists services, as established in subdivision 2, subject to federal approval, if provided
to recipients who are eligible for services under sections 256B.0622 and, 256B.0623, and
256B.0624 and are provided by a certified peer specialist who has completed the training
under subdivision 5.

    Sec. 8. Minnesota Statutes 2008, section 256B.0615, subdivision 3, is amended to read:
    Subd. 3. Eligibility. Peer support services may be made available to consumers
of (1) the intensive rehabilitative mental health services under section 256B.0622; and
(2) adult rehabilitative mental health services under section 256B.0623; and (3) crisis
stabilization services under section 256B.0624.

    Sec. 9. Minnesota Statutes 2008, section 256B.0622, subdivision 8, is amended to read:
    Subd. 8. Medical assistance payment for intensive rehabilitative mental health
services. (a) Payment for residential and nonresidential services in this section shall be
based on one daily rate per provider inclusive of the following services received by an
eligible recipient in a given calendar day: all rehabilitative services under this section,
staff travel time to provide rehabilitative services under this section, and nonresidential
crisis stabilization services under section 256B.0624.
(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each recipient for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.
(c) The host county shall recommend to the commissioner one rate for each entity
that will bill medical assistance for residential services under this section and two rates
one rate for each nonresidential provider. The first nonresidential rate is for recipients who
are not receiving residential services. The second nonresidential rate is for recipients
who are temporarily receiving residential services and need continued contact with the
nonresidential team to assure timely discharge from residential services. If a single entity
provides both services, one rate is established for the entity's residential services and
another rate for the entity's nonresidential services under this section. In developing these
rates, the host county shall consider and document:
(1) the cost for similar services in the local trade area;
(2) actual that the proposed costs incurred by entities providing the services are
allowable, allocable and reasonable, and are consistent with federal reimbursement
requirements including Code of Federal Regulations, title 48, chapter 1, part 31, as relating
to for-profit entities, and Office of Management and Budget Circular Number A-122,
as relating to nonprofit entities;
(3) the intensity and frequency of services to be provided to each recipient, including
the proposed overall number of units of service to be delivered;
(4) the degree to which recipients will receive services other than services under
this section;
(5) the costs of other services that will be separately reimbursed; and
(6) input from the local planning process authorized by the adult mental health
initiative under section 245.4661, regarding recipients' service needs.
(d) The rate for intensive rehabilitative mental health services must exclude room
and board, as defined in section 256I.03, subdivision 6, and services not covered under
this section, such as partial hospitalization, home care, and inpatient services. Physician
services that are not separately billed may be included in the rate to the extent that a
psychiatrist is a member of the treatment team. The county's recommendation shall
specify the period for which the rate will be applicable, not to exceed two years.
(e) When services under this section are provided by an assertive community team,
case management functions must be an integral part of the team.
(f) The rate for a provider must not exceed the rate charged by that provider for
the same service to other payors.
(g) The commissioner shall approve or reject the county's rate recommendation,
based on the commissioner's own analysis of the criteria in paragraph (c).
(h) Paragraph (c), clause (2), is effective for services provided on or after January
1, 2010, to December 31, 2011, and does not change contracts or agreements relating to
services provided before January 1, 2010.

    Sec. 10. Minnesota Statutes 2008, section 256B.0622, is amended by adding a
subdivision to read:
    Subd. 8a. Adjustments based on actual costs and units. (a) After each calendar
year, the commissioner shall compare actual costs and units of service for each provider to
the costs and units of service that were used as the basis for the approved rate.
(b) For purposes of this subdivision, "revenue" means actual units of service
multiplied by the approved rate and "allowed cost" means costs that are consistent with
the budget that was used as the basis for the approved rate, or other costs subsequently
approved by the county and the commissioner based on the criteria in subdivision 8,
paragraph (c), clause (2).
(c) The commissioner shall require repayment from the provider if the provider
has not incurred the costs included in the approved budget, if costs are determined to
be unallowable under the criteria in subdivision 8, paragraph (c), clause (2), or if a
provider's revenue is more than 105 percent of actual allowed costs due to utilization
beyond the projections in the approved budget. The repayment to the commissioner will
be proportional to the percent of total units of service reimbursed by the commissioner.
(d) If a provider's revenue is less than 95 percent of actual allowed costs due to
lower utilization than projected, the commissioner may adjust the rate so that the provider
can recover 95 percent of actual allowable costs. The resulting additional payment by the
commissioner will be proportional to the percent of total units of service reimbursed by
the commissioner.
(e) The commissioner has the authority to audit programs using all applicable state
and federal laws and regulations, including those referenced in subdivision 8, paragraph
(c), clause (2).
(f) This subdivision is effective for services provided on or after January 1, 2010,
to December 31, 2011, and does not change contracts or agreements relating to services
provided before January 1, 2010.

    Sec. 11. Minnesota Statutes 2008, section 256B.0623, subdivision 5, is amended to
read:
    Subd. 5. Qualifications of provider staff. Adult rehabilitative mental health
services must be provided by qualified individual provider staff of a certified provider
entity. Individual provider staff must be qualified under one of the following criteria:
    (1) a mental health professional as defined in section 245.462, subdivision 18,
clauses (1) to (5). If the recipient has a current diagnostic assessment by a licensed
mental health professional as defined in section 245.462, subdivision 18, clauses (1) to
(5), recommending receipt of adult mental health rehabilitative services, the definition of
mental health professional for purposes of this section includes a person who is qualified
under section 245.462, subdivision 18, clause (6), and who holds a current and valid
national certification as a certified rehabilitation counselor or certified psychosocial
rehabilitation practitioner;
    (2) a mental health practitioner as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professional;
    (3) a certified peer specialist under section 256B.0615. The certified peer specialist
must work under the clinical supervision of a mental health professional; or
    (4) a mental health rehabilitation worker. A mental health rehabilitation worker
means a staff person working under the direction of a mental health practitioner or mental
health professional and under the clinical supervision of a mental health professional in
the implementation of rehabilitative mental health services as identified in the recipient's
individual treatment plan who:
    (i) is at least 21 years of age;
    (ii) has a high school diploma or equivalent;
    (iii) has successfully completed 30 hours of training during the past two years
immediately prior to the date of hire, or before provision of direct services, in all of
the following areas: recipient rights, recipient-centered individual treatment planning,
behavioral terminology, mental illness, co-occurring mental illness and substance abuse,
psychotropic medications and side effects, functional assessment, local community
resources, adult vulnerability, recipient confidentiality; and
    (iv) meets the qualifications in subitem (A) or (B):
    (A) has an associate of arts degree or two years full-time postsecondary education
in one of the behavioral sciences or human services, or; is a registered nurse without a
bachelor's degree,; or who within the previous ten years has:
    (1) three years of personal life experience with serious and persistent mental illness;
    (2) three years of life experience as a primary caregiver to an adult with a serious
mental illness or traumatic brain injury; or
    (3) 4,000 hours of supervised paid work experience in the delivery of mental health
services to adults with a serious mental illness or traumatic brain injury; or
    (B)(1) is fluent in the non-English language or competent in the culture of the
ethnic group to which at least 20 percent of the mental health rehabilitation worker's
clients belong;
    (2) receives during the first 2,000 hours of work, monthly documented individual
clinical supervision by a mental health professional;
    (3) has 18 hours of documented field supervision by a mental health professional
or practitioner during the first 160 hours of contact work with recipients, and at least six
hours of field supervision quarterly during the following year;
    (4) has review and cosignature of charting of recipient contacts during field
supervision by a mental health professional or practitioner; and
    (5) has 40 15 hours of additional continuing education on mental health topics during
the first year of employment and 15 hours during every additional year of employment.

    Sec. 12. Minnesota Statutes 2008, section 256B.0624, subdivision 8, is amended to
read:
    Subd. 8. Adult crisis stabilization staff qualifications. (a) Adult mental health
crisis stabilization services must be provided by qualified individual staff of a qualified
provider entity. Individual provider staff must have the following qualifications:
(1) be a mental health professional as defined in section 245.462, subdivision 18,
clauses (1) to (5);
(2) be a mental health practitioner as defined in section 245.462, subdivision 17.
The mental health practitioner must work under the clinical supervision of a mental health
professional; or
(3) be a certified peer specialist under section 256B.0615. The certified peer
specialist must work under the clinical supervision of a mental health professional; or
(4) be a mental health rehabilitation worker who meets the criteria in section
256B.0623, subdivision 5, clause (3) (4); works under the direction of a mental health
practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professional.
(b) Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during
the past two years.

    Sec. 13. Minnesota Statutes 2008, section 256B.0625, subdivision 49, is amended to
read:
    Subd. 49. Community health worker. (a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if
the community health worker has:
    (1) received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculum; or
    (2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (5), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.
    (b) Community health workers must work under the supervision of a medical
assistance enrolled physician, registered nurse, advanced practice registered nurse,
mental health professional as defined in section 245.462, subdivision 18, clauses (1) to
(5), and section 245.4871, subdivision 27, clauses (1) to (5), or dentist, or work under
the supervision of a certified public health nurse operating under the direct authority of
an enrolled unit of government.
    (c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.

    Sec. 14. Minnesota Statutes 2008, section 256B.0943, subdivision 1, is amended to
read:
    Subdivision 1. Definitions. For purposes of this section, the following terms have
the meanings given them.
(a) "Children's therapeutic services and supports" means the flexible package of
mental health services for children who require varying therapeutic and rehabilitative
levels of intervention. The services are time-limited interventions that are delivered using
various treatment modalities and combinations of services designed to reach treatment
outcomes identified in the individual treatment plan.
(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
(c) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.
(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.
(e) "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A
provider may be culturally competent because the provider is of the same cultural or
ethnic group as the client or the provider has developed the knowledge and skills through
training and experience to provide services to culturally diverse clients.
(f) "Day treatment program" for children means a site-based structured program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.
(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11
.
(h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling, maintaining clinical records, consulting with others
about the client's mental health status, preparing reports, receiving clinical supervision
directly related to the client's psychotherapy session, and revising the client's individual
treatment plan.
(i) "Direction of mental health behavioral aide" means the activities of a mental
health professional or mental health practitioner in guiding the mental health behavioral
aide in providing services to a client. The direction of a mental health behavioral aide
must be based on the client's individualized treatment plan and meet the requirements in
subdivision 6, paragraph (b), clause (5).
(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15
. For persons at least age 18 but under age 21, mental illness has the meaning given in
section 245.462, subdivision 20, paragraph (a).
(k) "Individual behavioral plan" means a plan of intervention, treatment, and
services for a child written by a mental health professional or mental health practitioner,
under the clinical supervision of a mental health professional, to guide the work of the
mental health behavioral aide.
(l) "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21
.
(m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a trained paraprofessional to assist a child retain or generalize
psychosocial skills as taught by a mental health professional or mental health practitioner
and as described in the child's individual treatment plan and individual behavior plan.
Activities involve working directly with the child or child's family as provided in
subdivision 9, paragraph (b), clause (4).
(m) (n) "Mental health professional" means an individual as defined in section
245.4871, subdivision 27, clauses (1) to (5), or tribal vendor as defined in section 256B.02,
subdivision 7
, paragraph (b).
(n) (o) "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.
(o) (p) "Skills training" means individual, family, or group training, delivered by
or under the direction of a mental health professional, designed to improve the basic
functioning of the child with emotional disturbance and the child's family in the activities
of daily living and community living, and to improve the social functioning of the child
and the child's family in areas important to the child's maintaining or reestablishing
residency in the community. Individual, family, and group skills training must:
(1) consist of activities designed to promote skill development of the child and the
child's family in the use of age-appropriate daily living skills, interpersonal and family
relationships, and leisure and recreational services;
(2) consist of activities that will assist the family's understanding of normal child
development and to use parenting skills that will help the child with emotional disturbance
achieve the goals outlined in the child's individual treatment plan; and
(3) promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance. facilitate the acquisition
of psychosocial skills that are medically necessary to rehabilitate the child to an
age-appropriate developmental trajectory heretofore disrupted by a psychiatric illness
or to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is
subject to the following requirements:
(1) a mental health professional or a mental health practitioner must provide skills
training;
(2) the child must always be present during skills training; however, a brief absence
of the child for no more than ten percent of the session unit may be allowed to redirect or
instruct family members;
(3) skills training delivered to children or their families must be targeted to the
specific deficits or maladaptations of the child's mental health disorder and must be
prescribed in the child's individual treatment plan;
(4) skills training delivered to the child's family must teach skills needed by parents
to enhance the child's skill development and to help the child use in daily life the skills
previously taught by a mental health professional or mental health practitioner and to
develop or maintain a home environment that supports the child's progressive use skills;
(5) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:
(i) one mental health professional or one mental health practitioner under supervision
of a licensed mental health professional must work with a group of four to eight clients; or
(ii) two mental health professionals or two mental health practitioners under
supervision of a licensed mental health professional, or one professional plus one
practitioner must work with a group of nine to 12 clients.

    Sec. 15. Minnesota Statutes 2008, section 256B.0943, subdivision 2, is amended to
read:
    Subd. 2. Covered service components of children's therapeutic services and
supports. (a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports as defined in this section that an eligible
provider entity certified under subdivisions subdivision 4 and 5 provides to a client
eligible under subdivision 3.
(b) The service components of children's therapeutic services and supports are:
(1) individual, family, and group psychotherapy;
(2) individual, family, or group skills training provided by a mental health
professional or mental health practitioner;
(3) crisis assistance;
(4) mental health behavioral aide services; and
(5) direction of a mental health behavioral aide.
(c) Service components in paragraph (b) may be combined to constitute therapeutic
programs, including day treatment programs and therapeutic preschool programs.
Although day treatment and preschool programs have specific client and provider
eligibility requirements, medical assistance only pays for the service components listed in
paragraph (b).

    Sec. 16. Minnesota Statutes 2008, section 256B.0943, subdivision 4, is amended to
read:
    Subd. 4. Provider entity certification. (a) Effective July 1, 2003, the commissioner
shall establish an initial provider entity application and certification process and
recertification process to determine whether a provider entity has an administrative
and clinical infrastructure that meets the requirements in subdivisions 5 and 6. The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity that no longer meets the
requirements in this section. The county, tribe, and the commissioner shall be mutually
responsible and accountable for the county's, tribe's, and state's part of the certification,
recertification, and decertification processes.
(b) For purposes of this section, a provider entity must be:
(1) an Indian health services facility or a facility owned and operated by a tribe or
tribal organization operating as a 638 facility under Public Law 93-638 certified by the
state;
(2) a county-operated entity certified by the state; or
(3) a noncounty entity recommended for certification by the provider's host county
and certified by the state.

    Sec. 17. Minnesota Statutes 2008, section 256B.0943, subdivision 5, is amended to
read:
    Subd. 5. Provider entity administrative infrastructure requirements. (a) To be
an eligible provider entity under this section, a provider entity must have an administrative
infrastructure that establishes authority and accountability for decision making and
oversight of functions, including finance, personnel, system management, clinical practice,
and performance measurement. The provider must have written policies and procedures
that it reviews and updates every three years and distributes to staff initially and upon
each subsequent update.
(b) The administrative infrastructure written policies and procedures must include:
(1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
retention of culturally and linguistically competent providers; (ii) conducting a criminal
background check on all direct service providers and volunteers; (iii) investigating,
reporting, and acting on violations of ethical conduct standards; (iv) investigating,
reporting, and acting on violations of data privacy policies that are compliant with
federal and state laws; (v) utilizing volunteers, including screening applicants, training
and supervising volunteers, and providing liability coverage for volunteers; and (vi)
documenting that each mental health professional, mental health practitioner, or mental
health behavioral aide meets the applicable provider qualification criteria, training criteria
under subdivision 8, and clinical supervision or direction of a mental health behavioral
aide requirements under subdivision 6;
(2) fiscal procedures, including internal fiscal control practices and a process for
collecting revenue that is compliant with federal and state laws;
(3) if a client is receiving services from a case manager or other provider entity, a
service coordination process that ensures services are provided in the most appropriate
manner to achieve maximum benefit to the client. The provider entity must ensure
coordination and nonduplication of services consistent with county board coordination
procedures established under section 245.4881, subdivision 5;
(4) (3) a performance measurement system, including monitoring to determine
cultural appropriateness of services identified in the individual treatment plan, as
determined by the client's culture, beliefs, values, and language, and family-driven
services; and
(5) (4) a process to establish and maintain individual client records. The client's
records must include:
(i) the client's personal information;
(ii) forms applicable to data privacy;
(iii) the client's diagnostic assessment, updates, results of tests, individual treatment
plan, and individual behavior plan, if necessary;
(iv) documentation of service delivery as specified under subdivision 6;
(v) telephone contacts;
(vi) discharge plan; and
(vii) if applicable, insurance information.
(c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.

    Sec. 18. Minnesota Statutes 2008, section 256B.0943, subdivision 6, is amended to
read:
    Subd. 6. Provider entity clinical infrastructure requirements. (a) To be
an eligible provider entity under this section, a provider entity must have a clinical
infrastructure that utilizes diagnostic assessment, an individualized treatment plan plans,
service delivery, and individual treatment plan review that are culturally competent,
child-centered, and family-driven to achieve maximum benefit for the client. The provider
entity must review, and update as necessary the clinical policies and procedures every
three years and must distribute the policies and procedures to staff initially and upon
each subsequent update.
    (b) The clinical infrastructure written policies and procedures must include policies
and procedures for:
    (1) providing or obtaining a client's diagnostic assessment that identifies acute and
chronic clinical disorders, co-occurring medical conditions, sources of psychological
and environmental problems, and including a functional assessment. The functional
assessment component must clearly summarize the client's individual strengths and needs;
    (2) developing an individual treatment plan that is:
    (i) is based on the information in the client's diagnostic assessment;
(ii) identified goals and objectives of treatment, treatment strategy, schedule for
accomplishing treatment goals and objectives, and the individuals responsible for
providing treatment services and supports;
    (ii) (iii) is developed no later than the end of the first psychotherapy session after
the completion of the client's diagnostic assessment by the a mental health professional
who provides the client's psychotherapy and before the provision of children's therapeutic
services and supports;
    (iii) (iv) is developed through a child-centered, family-driven, culturally appropriate
planning process that identifies service needs and individualized, planned, and culturally
appropriate interventions that contain specific treatment goals and objectives for the client
and the client's family or foster family;
    (iv) (v) is reviewed at least once every 90 days and revised, if necessary; and
    (v) (vi) is signed by the clinical supervisor and by the client or, if appropriate, by the
client's parent or other person authorized by statute to consent to mental health services
for the client;
    (3) developing an individual behavior plan that documents services treatment
strategies to be provided by the mental health behavioral aide. The individual behavior
plan must include:
    (i) detailed instructions on the service treatment strategies to be provided;
    (ii) time allocated to each service treatment strategy;
    (iii) methods of documenting the child's behavior;
    (iv) methods of monitoring the child's progress in reaching objectives; and
    (v) goals to increase or decrease targeted behavior as identified in the individual
treatment plan;
    (4) providing clinical supervision of the mental health practitioner and mental health
behavioral aide. A mental health professional must document the clinical supervision
the professional provides by cosigning individual treatment plans and making entries in
the client's record on supervisory activities. Clinical supervision does not include the
authority to make or terminate court-ordered placements of the child. A clinical supervisor
must be available for urgent consultation as required by the individual client's needs or
the situation. Clinical supervision may occur individually or in a small group to discuss
treatment and review progress toward goals. The focus of clinical supervision must be the
client's treatment needs and progress and the mental health practitioner's or behavioral
aide's ability to provide services;
    (4a) CTSS certified provider entities providing meeting day treatment and
therapeutic preschool programs must meet the conditions in items (i) to (iii):
    (i) the supervisor must be present and available on the premises more than 50
percent of the time in a five-working-day period during which the supervisee is providing
a mental health service;
    (ii) the diagnosis and the client's individual treatment plan or a change in the
diagnosis or individual treatment plan must be made by or reviewed, approved, and signed
by the supervisor; and
    (iii) every 30 days, the supervisor must review and sign the record of indicating the
supervisor has reviewed the client's care for all activities in the preceding 30-day period;
    (4b) meeting the clinical supervision standards in items (i) to (iii) for all other
services provided under CTSS, clinical supervision standards provided in items (i) to
(iii) must be used:
    (i) medical assistance shall reimburse for services provided by a mental health
practitioner who maintains a consulting relationship with a mental health professional who
accepts full professional responsibility and is present on site for at least one observation
during the first 12 hours in which the mental health practitioner provides the individual,
family, or group skills training to the child or the child's family;
(ii) medical assistance shall reimburse for services provided by a mental health
behavioral aide who maintains a consulting relationship with a mental health professional
who accepts full professional responsibility and has an approved plan for clinical
supervision of the behavioral aide. Plans will be approved in accordance with supervision
standards promulgated by the commissioner of human services;
    (ii) thereafter, (iii) the mental health professional is required to be present on site
for observation as clinically appropriate when the mental health practitioner or mental
health behavioral aide is providing individual, family, or group skills training to the child
or the child's family CTSS services; and
    (iii) (iv) when conducted, the observation must be a minimum of one clinical
unit. The on-site presence of the mental health professional must be documented in the
child's record and signed by the mental health professional who accepts full professional
responsibility;
    (5) providing direction to a mental health behavioral aide. For entities that employ
mental health behavioral aides, the clinical supervisor must be employed by the provider
entity or other certified children's therapeutic supports and services provider entity to
ensure necessary and appropriate oversight for the client's treatment and continuity
of care. The mental health professional or mental health practitioner giving direction
must begin with the goals on the individualized treatment plan, and instruct the mental
health behavioral aide on how to construct therapeutic activities and interventions that
will lead to goal attainment. The professional or practitioner giving direction must also
instruct the mental health behavioral aide about the client's diagnosis, functional status,
and other characteristics that are likely to affect service delivery. Direction must also
include determining that the mental health behavioral aide has the skills to interact with
the client and the client's family in ways that convey personal and cultural respect and
that the aide actively solicits information relevant to treatment from the family. The aide
must be able to clearly explain the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision
and requires the professional or practitioner providing it to continuously evaluate the
mental health behavioral aide's ability to carry out the activities of the individualized
treatment plan and the individualized behavior plan. When providing direction, the
professional or practitioner must:
    (i) review progress notes prepared by the mental health behavioral aide for accuracy
and consistency with diagnostic assessment, treatment plan, and behavior goals and the
professional or practitioner must approve and sign the progress notes;
    (ii) identify changes in treatment strategies, revise the individual behavior plan,
and communicate treatment instructions and methodologies as appropriate to ensure
that treatment is implemented correctly;
    (iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;
    (iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; and
    (v) record the results of any evaluation and corrective actions taken to modify the
work of the mental health behavioral aide;
    (6) providing service delivery that implements the individual treatment plan and
meets the requirements under subdivision 9; and
    (7) individual treatment plan review. The review must determine the extent to which
the services have met the goals and objectives in the previous treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the clinical supervisor and by the client, if appropriate, and by the client's
parent or other person authorized by statute to give consent to the mental health services
for the child.

    Sec. 19. Minnesota Statutes 2008, section 256B.0943, subdivision 7, is amended to
read:
    Subd. 7. Qualifications of individual and team providers. (a) An individual
or team provider working within the scope of the provider's practice or qualifications
may provide service components of children's therapeutic services and supports that are
identified as medically necessary in a client's individual treatment plan.
(b) An individual provider must be qualified as:
(1) a mental health professional as defined in subdivision 1, paragraph (m); or
(2) a mental health practitioner as defined in section 245.4871, subdivision 26. The
mental health practitioner must work under the clinical supervision of a mental health
professional; or
(3) a mental health behavioral aide working under the direction clinical supervision
of a mental health professional to implement the rehabilitative mental health services
identified in the client's individual treatment plan and individual behavior plan.
(A) A level I mental health behavioral aide must:
(i) be at least 18 years old;
(ii) have a high school diploma or general equivalency diploma (GED) or two years
of experience as a primary caregiver to a child with severe emotional disturbance within
the previous ten years; and
(iii) meet preservice and continuing education requirements under subdivision 8.
(B) A level II mental health behavioral aide must:
(i) be at least 18 years old;
(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents; and
(iii) meet preservice and continuing education requirements in subdivision 8.
(c) A preschool program multidisciplinary team must include at least one mental
health professional and one or more of the following individuals under the clinical
supervision of a mental health professional:
(i) a mental health practitioner; or
(ii) a program person, including a teacher, assistant teacher, or aide, who meets the
qualifications and training standards of a level I mental health behavioral aide.
(d) A day treatment multidisciplinary team must include at least one mental health
professional and one mental health practitioner.

    Sec. 20. Minnesota Statutes 2008, section 256B.0943, subdivision 9, is amended to
read:
    Subd. 9. Service delivery criteria. (a) In delivering services under this section, a
certified provider entity must ensure that:
    (1) each individual provider's caseload size permits the provider to deliver services
to both clients with severe, complex needs and clients with less intensive needs. The
provider's caseload size should reasonably enable the provider to play an active role in
service planning, monitoring, and delivering services to meet the client's and client's
family's needs, as specified in each client's individual treatment plan;
    (2) site-based programs, including day treatment and preschool programs, provide
staffing and facilities to ensure the client's health, safety, and protection of rights, and that
the programs are able to implement each client's individual treatment plan;
    (3) a day treatment program is provided to a group of clients by a multidisciplinary
team under the clinical supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections 144.50
to 144.55; (ii) a community mental health center under section 245.62; and or (iii) an
entity that is under contract with the county board to operate a program that meets the
requirements of sections 245.4712, subdivision 2, and or 245.4884, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must
stabilize the client's mental health status while developing and improving the client's
independent living and socialization skills. The goal of the day treatment program must
be to reduce or relieve the effects of mental illness and provide training to enable the
client to live in the community. The program must be available at least one day a week
for a two-hour three-hour time block. The three-hour two-hour time block must include
at least one hour, but no more than two hours, of individual or group psychotherapy.
The remainder of the three-hourtime block may include recreation therapy, socialization
therapy, or independent living skills therapy, but only if the therapies are included in the
client's individual treatment plan The remainder of the structured treatment program
may include individual or group psychotherapy and individual or group skills training, if
included in the client's individual treatment plan. Day treatment programs are not part of
inpatient or residential treatment services. A day treatment program may provide fewer
than the minimally required hours for a particular child during a billing period in which
the child is transitioning into, or out of, the program; and
    (4) a therapeutic preschool program is a structured treatment program offered
to a child who is at least 33 months old, but who has not yet reached the first day of
kindergarten, by a preschool multidisciplinary team in a day program licensed under
Minnesota Rules, parts 9503.0005 to 9503.0175. The program must be available at
least one day a week for a minimum two-hour time block two hours per day, five days
per week, and 12 months of each calendar year. The structured treatment program may
include individual or group psychotherapy and recreation therapy, socialization therapy,
or independent living skills therapy individual or group skills training, if included in the
client's individual treatment plan. A therapeutic preschool program may provide fewer
than the minimally required hours for a particular child during a billing period in which
the child is transitioning into, or out of, the program.
    (b) A provider entity must deliver the service components of children's therapeutic
services and supports in compliance with the following requirements:
    (1) individual, family, and group psychotherapy must be delivered as specified in
Minnesota Rules, part 9505.0323;
    (2) individual, family, or group skills training must be provided by a mental health
professional or a mental health practitioner who has a consulting relationship with a
mental health professional who accepts full professional responsibility for the training;
    (3) crisis assistance must be time-limited and designed to resolve or stabilize crisis
through arrangements for direct intervention and support services to the child and the
child's family. Crisis assistance must utilize resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family as evidenced by
a sudden change in behavior with negative consequences for well being, a loss of usual
coping mechanisms, or the presentation of danger to self or others;
    (4) mental health behavioral aide services must be medically necessary services that
are provided by a mental health behavioral aide must be treatment services, identified in
the child's individual treatment plan and individual behavior plan, which are performed
minimally by a paraprofessional qualified according to subdivision 7, paragraph (b),
clause (3), and which are designed to improve the functioning of the child and support
the family in activities of daily and community living. in the progressive use of
developmentally appropriate psychosocial skills. Activities involve working directly with
the child, child-peer groupings, or child-family groupings to practice, repeat, reintroduce,
and master the skills defined in subdivision 1, paragraph (p), as previously taught by a
mental health professional or mental health practitioner including:
(i) providing cues or prompts in skill-building peer-to-peer or parent-child
interactions so that the child progressively recognizes and responds to the cues
independently;
(ii) performing as a practice partner or role-play partner;
(iii) reinforcing the child's accomplishments;
(iv) generalizing skill-building activities in the child's multiple natural settings;
(v) assigning further practice activities; and
(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.
A mental health behavioral aide must document the delivery of services in written progress
notes. The mental health behavioral aide must implement goals in the treatment plan for
the child's emotional disturbance that allow the child to acquire developmentally and
therapeutically appropriate daily living skills, social skills, and leisure and recreational
skills through targeted activities. These activities may include:
    (i) assisting a child as needed with skills development in dressing, eating, and
toileting;
    (ii) assisting, monitoring, and guiding the child to complete tasks, including
facilitating the child's participation in medical appointments;
    (iii) observing the child and intervening to redirect the child's inappropriate behavior;
    (iv) assisting the child in using age-appropriate self-management skills as related
to the child's emotional disorder or mental illness, including problem solving, decision
making, communication, conflict resolution, anger management, social skills, and
recreational skills;
    (v) implementing deescalation techniques as recommended by the mental health
professional;
    (vi) implementing any other mental health service that the mental health professional
has approved as being within the scope of the behavioral aide's duties; or
    (vii) assisting the parents to develop and use parenting skills that help the child
achieve the goals outlined in the child's individual treatment plan or individual behavioral
plan. Parenting skills must be directed exclusively to the child's treatment treatment
strategies in the individual treatment plan and the individual behavior plan. The mental
health behavioral aide must document the delivery of services in written progress notes.
Progress notes must reflect implementation of the treatment strategies, as performed by
the mental health behavioral aide and the child's responses to the treatment strategies; and
    (5) direction of a mental health behavioral aide must include the following:
    (i) a total of one hour of on-site observation by a mental health professional during
the first 12 hours of service provided to a child;
    (ii) ongoing on-site observation by a mental health professional or mental health
practitioner for at least a total of one hour during every 40 hours of service provided
to a child; and
    (iii) immediate accessibility of the mental health professional or mental health
practitioner to the mental health behavioral aide during service provision.

    Sec. 21. Minnesota Statutes 2008, section 256B.0944, subdivision 5, is amended to
read:
    Subd. 5. Mobile crisis intervention staff qualifications. (a) To provide children's
mental health mobile crisis intervention services, a mobile crisis intervention team must
include:
(1) at least two mental health professionals as defined in section 256B.0943,
subdivision 1
, paragraph (m) (n); or
(2) a combination of at least one mental health professional and one mental health
practitioner as defined in section 245.4871, subdivision 26, with the required mental
health crisis training and under the clinical supervision of a mental health professional on
the team.
(b) The team must have at least two people with at least one member providing
on-site crisis intervention services when needed. Team members must be experienced in
mental health assessment, crisis intervention techniques, and clinical decision making
under emergency conditions and have knowledge of local services and resources. The
team must recommend and coordinate the team's services with appropriate local resources,
including the county social services agency, mental health service providers, and local law
enforcement, if necessary.
Presented to the governor May 20, 2009
Signed by the governor May 22, 2009, 2:46 p.m.

700 State Office Building, 100 Rev. Dr. Martin Luther King Jr. Blvd., St. Paul, MN 55155 ♦ Phone: (651) 296-2868 ♦ TTY: 1-800-627-3529 ♦ Fax: (651) 296-0569