1.1                          A bill for an act 
  1.2             relating to human services; defining what services are 
  1.3             covered under intensive early intervention behavior 
  1.4             therapy services for children with autism spectrum 
  1.5             disorders; amending Minnesota Statutes 2001 
  1.6             Supplement, section 256B.0625, subdivision 5a. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 2001 Supplement, section 
  1.9   256B.0625, subdivision 5a, is amended to read: 
  1.10     Subd. 5a.  [INTENSIVE EARLY INTERVENTION BEHAVIOR THERAPY 
  1.11  SERVICES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS.] (a) 
  1.12  [COVERAGE.] Medical assistance covers home-based intensive early 
  1.13  intervention behavior therapy for children with autism spectrum 
  1.14  disorders.  Children with autism spectrum disorder, and their 
  1.15  custodial parents or foster parents, may access other covered 
  1.16  services to treat autism spectrum disorder, and are not required 
  1.17  to receive intensive early intervention behavior therapy 
  1.18  services under this subdivision.  ~~Intensive early intervention~~ 
  1.19  ~~behavior therapy does not include coverage for services to treat~~ 
  1.20  ~~developmental disorders of language, early onset psychosis,~~ 
  1.21  ~~Rett's disorder, selective mutism, social anxiety disorder,~~ 
  1.22  ~~stereotypic movement disorder, dementia, obsessive compulsive~~ 
  1.23  ~~disorder, schizoid personality disorder, avoidant personality~~ 
  1.24  ~~disorder, or reactive attachment disorder.  If a child with~~ 
  1.25  ~~autism spectrum disorder is diagnosed to have one or more of~~ 
  1.26  ~~these conditions, intensive early intervention behavior therapy~~ 
  2.1   ~~includes coverage only for services necessary to treat the~~ 
  2.2   ~~autism spectrum disorder.~~ 
  2.3      (b) [PURPOSE OF INTENSIVE EARLY INTERVENTION BEHAVIOR 
  2.4   THERAPY SERVICES (IEIBTS).] The purpose of IEIBTS is to improve 
  2.5   the child's behavioral functioning, to prevent development of 
  2.6   challenging behaviors, to eliminate autistic behaviors, to 
  2.7   reduce the risk of out-of-home placement, and to establish 
  2.8   independent typical functioning in language and social 
  2.9   behavior.  The procedures used to accomplish these goals are 
  2.10  based upon research in applied behavior analysis. 
  2.11     (c) [ELIGIBLE CHILDREN.] A child is eligible to initiate 
  2.12  IEIBTS if, the child meets the additional eligibility criteria 
  2.13  in paragraph (d) and in a diagnostic assessment by a mental 
  2.14  health professional who is not under the employ of the service 
  2.15  provider, the child: 
  2.16     (1) is found to have an autism spectrum disorder; 
  2.17     (2) has a current IQ of either untestable, or at least 30; 
  2.18     (3) if nonverbal, initiated behavior therapy by 42 months 
  2.19  of age; 
  2.20     (4) if verbal, initiated behavior therapy by 48 months of 
  2.21  age; or 
  2.22     (5) if having an IQ of at least 50, initiated behavior 
  2.23  therapy by 84 months of age. 
  2.24  To continue after six-month individualized treatment plan (ITP) 
  2.25  reviews, at least one of the child's custodial parents or foster 
  2.26  parents must participate in an average of at least five hours of 
  2.27  documented behavior therapy per week for six months, and 
  2.28  consistently implement behavior therapy recommendations 24 hours 
  2.29  a day~~.  To continue after six-month individualized treatment~~ 
  2.30  ~~plan (ITP) reviews,~~ and the child must show documented progress 
  2.31  toward mastery of six-month benchmark behavior objectives.  The 
  2.32  maximum number of months during which services may be billed is 
  2.33  54, or up to and including the month of ~~August~~ October in the 
  2.34  first year in which the child completes first grade, whichever 
  2.35  comes last.  If significant progress towards treatment goals has 
  2.36  not been achieved after 24 months of treatment, treatment must 
  3.1   be discontinued. 
  3.2      (d) ~~[ADDITIONAL ELIGIBILITY CRITERIA.] A child is eligible~~ 
  3.3   ~~to initiate IEIBTS if:~~ 
  3.4      ~~(1) in medical and diagnostic assessments by medical and~~ 
  3.5   ~~mental health professionals, it is determined that the child~~ 
  3.6   ~~does not have severe or profound mental retardation;~~ 
  3.7      ~~(2) an accurate assessment of the child's hearing has been~~ 
  3.8   ~~performed, including audiometry if the brain stem auditory~~ 
  3.9   ~~evokes response;~~ 
  3.10     ~~(3) a blood lead test has been performed prior to~~ 
  3.11  ~~initiation of treatment; and~~ 
  3.12     ~~(4) an EEG or neurologic evaluation is done, prior to~~ 
  3.13  ~~initiation of treatment, if the child has a history of staring~~ 
  3.14  ~~spells or developmental regression.~~  
  3.15     ~~(e)~~ [COVERED SERVICES.] The focus of IEIBTS must be to 
  3.16  treat the principal diagnostic features of the autism spectrum 
  3.17  disorder.  All IEIBTS must be delivered by a team of 
  3.18  practitioners under the consistent supervision of a single 
  3.19  clinical supervisor.  A mental health professional must develop 
  3.20  the ITP for IEIBTS.  The ITP must include six-month benchmark 
  3.21  behavior objectives.  All behavior therapy must be based upon 
  3.22  research in applied behavior analysis, with an emphasis upon 
  3.23  positive reinforcement of carefully task-analyzed skills for 
  3.24  optimum rates of progress.  All behavior therapy must be 
  3.25  consistently applied and generalized throughout the 24-hour day 
  3.26  and seven-day week by all of the child's regular care 
  3.27  providers.  ~~When placing the child in school activities, a~~ 
  3.28  ~~majority of the peers must have no mental health diagnosis, and~~ 
  3.29  ~~the child must have sufficient social skills to succeed with 80~~ 
  3.30  ~~percent of the school activities.~~  Reactive consequences, such 
  3.31  as redirection, correction, positive practice, or time-out, must 
  3.32  be used only when necessary to improve the child's success when 
  3.33  proactive procedures alone have not been effective.  IEIBTS must 
  3.34  be delivered by a team of behavior therapy practitioners who are 
  3.35  employed under the direction of the same agency.  The team may 
  3.36  deliver up to 200 billable hours per year of direct clinical 
  4.1   supervisor services, up to ~~700~~ 750 billable hours per year of 
  4.2   senior behavior therapist services, and up to 1,800 billable 
  4.3   hours per year of direct behavior therapist services.  A 
  4.4   one-hour clinical review meeting for the child, parents, and 
  4.5   staff must be scheduled 50 weeks a year, at which behavior 
  4.6   therapy is reviewed and planned.  At least one-quarter of the 
  4.7   annual clinical supervisor billable hours shall consist of 
  4.8   on-site clinical meeting time.  At least one-half of the annual 
  4.9   senior behavior therapist billable hours shall consist of direct 
  4.10  services to the child or parents.  All of the behavioral 
  4.11  therapist billable hours shall consist of direct on-site 
  4.12  services to the child or parents.  None of the senior behavior 
  4.13  therapist billable hours or behavior therapist billable hours 
  4.14  shall consist of clinical meeting time.  ~~If there is any~~ 
  4.15  ~~regression of the autistic spectrum disorder after 12 months of~~ 
  4.16  ~~therapy, a neurologic consultation must be performed.~~ 
  4.17     ~~(f)~~ (e) [PROVIDER QUALIFICATIONS.] The provider agency must 
  4.18  be capable of delivering consistent applied behavior analysis 
  4.19  (ABA) based behavior therapy in the home.  The site director of 
  4.20  the agency must be a mental health professional and a board 
  4.21  certified behavior analyst certified by the behavior analyst 
  4.22  certification board.  Each clinical supervisor must be a 
  4.23  certified associate behavior analyst certified by the behavior 
  4.24  analyst certification board or have equivalent experience in 
  4.25  applied behavior analysis. 
  4.26     ~~(g)~~ (f) [SUPERVISION REQUIREMENTS.] (1) Each behavior 
  4.27  therapist practitioner must be continuously supervised while in 
  4.28  the home until the practitioner has mastered competencies for 
  4.29  independent practice.  Each behavior therapist must have 
  4.30  mastered three credits of academic content and practice in an 
  4.31  applied behavior analysis sequence at an accredited university 
  4.32  before providing more than 12 months of therapy.  A college 
  4.33  degree or minimum hours of experience are not required.  Each 
  4.34  behavior therapist must continue training through weekly direct 
  4.35  observation by the senior behavior therapist, through 
  4.36  demonstrated performance in clinical meetings with the clinical 
  5.1   supervisor, and annual training in applied behavior analysis. 
  5.2      (2) Each senior behavior therapist practitioner must have 
  5.3   mastered the senior behavior therapy competencies, completed one 
  5.4   year of practice as a behavior therapist, and six months of 
  5.5   co-therapy training with another senior behavior therapist or 
  5.6   have an equivalent amount of experience in applied behavior 
  5.7   analysis.  Each senior behavior therapist must have mastered 12 
  5.8   credits of academic content and practice in an applied behavior 
  5.9   analysis sequence at an accredited university before providing 
  5.10  more than 12 months of senior behavior therapy.  Each senior 
  5.11  behavior therapist must continue training through demonstrated 
  5.12  performance in clinical meetings with the clinical supervisor, 
  5.13  and annual training in applied behavior analysis. 
  5.14     (3) Each clinical supervisor practitioner must have 
  5.15  mastered the clinical supervisor and family consultation 
  5.16  competencies, completed two years of practice as a senior 
  5.17  behavior therapist and one year of co-therapy training with 
  5.18  another clinical supervisor, or equivalent experience in applied 
  5.19  behavior analysis.  Each clinical supervisor must continue 
  5.20  training through annual training in applied behavior analysis. 
  5.21     ~~(h)~~ (g) [PLACE OF SERVICE.] IEIBTS are provided primarily 
  5.22  in the child's home and community.  Services may be provided in 
  5.23  the child's natural school or preschool classroom, home of a 
  5.24  relative, natural recreational setting, or day care. 
  5.25     ~~(i)~~ (h) [PRIOR AUTHORIZATION REQUIREMENTS.] Prior 
  5.26  authorization shall be required for services provided after 200 
  5.27  hours of clinical supervisor, ~~700~~ 750 hours of senior behavior 
  5.28  therapist, or 1,800 hours of behavior therapist services per 
  5.29  year. 
  5.30     ~~(j)~~ (i) [PAYMENT RATES.] The following payment rates apply: 
  5.31     (1) for an IEIBTS clinical supervisor practitioner under 
  5.32  supervision of a mental health professional, the lower of the 
  5.33  submitted charge or $67 per hour unit; 
  5.34     (2) for an IEIBTS senior behavior therapist practitioner 
  5.35  under supervision of a mental health professional, the lower of 
  5.36  the submitted charge or ~~$37~~ $50 per hour unit; or 
  6.1      (3) for an IEIBTS behavior therapist practitioner under 
  6.2   supervision of a mental health professional, the lower of the 
  6.3   submitted charge or $27 per hour unit. 
  6.4   An IEIBTS practitioner may receive payment for trips in which 
  6.5   the travel time ~~which~~ exceeds ~~50~~ 40 minutes one-way from the 
  6.6   agency's office address.  The maximum payment allowed will be 
  6.7   $0.51 per minute for up to a maximum of ~~300~~ 180 hours per year. 
  6.8      (j) [EXCLUDED SERVICES.] For any week during which the 
  6.9   above charges are made to medical assistance, payments for the 
  6.10  following services are excluded:  supervising mental health 
  6.11  professional ~~hours and~~, personal care attendant, home-based 
  6.12  mental health, family-community support, ~~or~~ mental health 
  6.13  behavioral aide, psychotherapy, or mental health day treatment 
  6.14  hours.  IEIBTS may not be simultaneously covered by a 
  6.15  developmental disability or MR/RC waiver. 
  6.16     (k) [REPORT.] The commissioner shall collect evidence of 
  6.17  the effectiveness of intensive early intervention behavior 
  6.18  therapy services and present a report to the legislature by July 
  6.19  1, 2006. 
  6.20     <b>[EFFECTIVE DATE.]</b> This section is effective January 1, 2003.