1.1 	A bill for an act
1.2 	relating to human services; modifying children's therapeutic services; exempting 
1.3 	certain programs from licensing requirements; amending Minnesota Statutes 
1.4 	2008, sections 157.16, by adding a subdivision; 245.4871, subdivision 10; 
1.5 	256B.0943, subdivisions 4, 6, 9.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2008, section 157.16, is amended by adding a 
1.8 	subdivision to read:
1.9 		Subd. 5.Exemption for certain establishments. This section does not apply to 
1.10 	group residential facilities of ten or fewer beds licensed by the commissioner of human 
1.11 	services under Minnesota Rules, chapter 2960, or Minnesota Rules, parts 9520.0500 
1.12 	to 9520.0670, provided the facility employs or contracts with a certified food manager 
1.13 	under Minnesota Rules, part 4626.2015.

1.14 	Sec. 2. Minnesota Statutes 2008, section 245.4871, subdivision 10, is amended to read:
1.15 		Subd. 10.Day treatment services. "Day treatment," "day treatment services," or 
1.16 	"day treatment program" means a structured program of treatment and care provided to a 
1.17 	child in:
1.18 	(1) an outpatient hospital accredited by the Joint Commission on Accreditation of 
1.19 	Health Organizations and licensed under sections 144.50 to 144.55;  
1.20 	(2) a community mental health center under section 245.62;  
1.21 	(3) an entity that is under contract with the county board to operate a program that 
1.22 	meets the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts 
1.23 	9505.0170 to 9505.0475; or  
2.1 	(4) an entity that operates a program that meets the requirements of section 
2.2 	245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is 
2.3 	under contract with an entity that is under contract with a county board.  
2.4 	Day treatment consists of group psychotherapy and other intensive therapeutic 
2.5 	services that are provided for a minimum three-hour two-hour  time block by a 
2.6 	multidisciplinary staff under the clinical supervision of a mental health professional. 
2.7 	Day treatment may include education and consultation provided to families and 
2.8 	other individuals as an extension of the treatment process. The services are aimed at 
2.9 	stabilizing the child's mental health status, and developing and improving the child's daily 
2.10 	independent living and socialization skills. Day treatment services are distinguished from 
2.11 	day care by their structured therapeutic program of psychotherapy services. Day treatment 
2.12 	services are not a part of inpatient hospital or residential treatment services. Day treatment 
2.13 	services for a child are an integrated set of education, therapy, and family interventions.
2.14 	A day treatment service must be available to a child at least five days up to 15 hours 
2.15 	 a week throughout the year and must be coordinated with, integrated with, or part of an 
2.16 	education program offered by the child's school.

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

2.34 	Sec. 4. Minnesota Statutes 2008, section 256B.0943, subdivision 6, is amended to read:
3.1 		Subd. 6.Provider entity clinical infrastructure requirements. (a) To be 
3.2 	an eligible provider entity under this section, a provider entity must have a clinical 
3.3 	infrastructure that utilizes diagnostic assessment, an individualized treatment plan, 
3.4 	service delivery, and individual treatment plan review that are culturally competent, 
3.5 	child-centered, and family-driven to achieve maximum benefit for the client. The provider 
3.6 	entity must review,  and update as necessary, the clinical policies and procedures every 
3.7 	three years and must distribute the policies and procedures to staff initially and upon 
3.8 	each subsequent update.
3.9 	(b) The clinical infrastructure written policies and procedures must include policies 
3.10 	and procedures for:
3.11 	(1) providing or obtaining a client's diagnostic assessment that identifies acute and 
3.12 	chronic clinical disorders, co-occurring medical conditions, sources of psychological 
3.13 	and environmental problems, and including a functional assessment. The functional 
3.14 	assessment component must clearly summarize the client's individual strengths and needs;
3.15 	(2) developing an individual treatment plan that is:
3.16 	(i) based on the information in the client's diagnostic assessment;
3.17 	(ii) developed no later than the end of the first psychotherapy session after the 
3.18 	completion of the client's diagnostic assessment by the mental health professional who 
3.19 	provides the client's psychotherapy;
3.20 	(iii) developed through a child-centered, family-driven planning process that 
3.21 	identifies service needs and individualized, planned, and culturally appropriate 
3.22 	interventions that contain specific treatment goals and objectives for the client and the 
3.23 	client's family or foster family;
3.24 	(iv) reviewed at least once every 90 days and revised, if necessary; and
3.25 	(v) signed by the client or, if appropriate, by the client's parent or other person 
3.26 	authorized by statute to consent to mental health services for the client;
3.27 	(3) developing an individual behavior plan that documents services to be provided 
3.28 	by the mental health behavioral aide. The individual behavior plan must include:
3.29 	(i) detailed instructions on the service to be provided;
3.30 	(ii) time allocated to each service;
3.31 	(iii) methods of documenting the child's behavior;
3.32 	(iv) methods of monitoring the child's progress in reaching objectives; and
3.33 	(v) goals to increase or decrease targeted behavior as identified in the individual 
3.34 	treatment plan;
3.35 	(4) clinical supervision of the mental health practitioner and mental health behavioral 
3.36 	aide. A mental health professional must document the clinical supervision the professional 
4.1 	provides by cosigning individual treatment plans and making entries in the client's record 
4.2 	on supervisory activities. Clinical supervision does not include the authority to make or 
4.3 	terminate court-ordered placements of the child. A clinical supervisor must be available 
4.4 	for urgent consultation as required by the individual client's needs or the situation. Clinical 
4.5 	supervision may occur individually or in a small group to discuss treatment and review 
4.6 	progress toward goals. The focus of clinical supervision must be the client's treatment 
4.7 	needs and progress and the mental health practitioner's or behavioral aide's ability to 
4.8 	provide services;
4.9 	(4a) CTSS certified provider entities providing day treatment programs must meet 
4.10 	the conditions in items (i) to (iii):
4.11 	(i) the supervisor must be present and available on the premises more than 50 
4.12 	percent of the time in a five-working-day period during which the supervisee is providing 
4.13 	a mental health service;
4.14 	(ii) the diagnosis and the client's individual treatment plan or a change in the 
4.15 	diagnosis or individual treatment plan must be made by or reviewed, approved, and signed 
4.16 	by the supervisor; and
4.17 	(iii) every 30 days, the supervisor must review and sign the record of indicating the 
4.18 	supervisor has reviewed  the client's care for all activities in the preceding 30-day period;
4.19 	(4b) for all other services provided under CTSS, clinical supervision standards 
4.20 	provided in items (i) to (iii) must be used:
4.21 	(i) medical assistance shall reimburse a mental health practitioner who maintains a 
4.22 	consulting relationship with a mental health professional who accepts full professional 
4.23 	responsibility and is present on site for at least one observation during the first 12 hours 
4.24 	in which the mental health practitioner provides the individual, family, or group skills 
4.25 	training to the child or the child's family;
4.26 	(ii) thereafter, the mental health professional is required to be present on site for 
4.27 	observation as clinically appropriate when the mental health practitioner is providing 
4.28 	individual, family, or group skills training to the child or the child's family; and
4.29 	(iii) when conducted, the observation must be a minimum of one clinical unit. The 
4.30 	on-site presence of the mental health professional must be documented in the child's record 
4.31 	and signed by the mental health professional who accepts full professional responsibility;
4.32 	(5) providing direction to a mental health behavioral aide. For entities that employ 
4.33 	mental health behavioral aides, the clinical supervisor must be employed by the provider 
4.34 	entity or other certified children's therapeutic supports and services provider entity to 
4.35 	ensure necessary and appropriate oversight for the client's treatment and continuity 
4.36 	of care. The mental health professional or mental health practitioner giving direction 
5.1 	must begin with the goals on the individualized treatment plan, and instruct the mental 
5.2 	health behavioral aide on how to construct therapeutic activities and interventions that 
5.3 	will lead to goal attainment. The professional or practitioner giving direction must also 
5.4 	instruct the mental health behavioral aide about the client's diagnosis, functional status, 
5.5 	and other characteristics that are likely to affect service delivery. Direction must also 
5.6 	include determining that the mental health behavioral aide has the skills to interact with 
5.7 	the client and the client's family in ways that convey personal and cultural respect and 
5.8 	that the aide actively solicits information relevant to treatment from the family. The aide 
5.9 	must be able to clearly explain the activities the aide is doing with the client and the 
5.10 	activities' relationship to treatment goals. Direction is more didactic than is supervision 
5.11 	and requires the professional or practitioner providing it to continuously evaluate the 
5.12 	mental health behavioral aide's ability to carry out the activities of the individualized 
5.13 	treatment plan and the individualized behavior plan. When providing direction, the 
5.14 	professional or practitioner must:
5.15 	(i) review progress notes prepared by the mental health behavioral aide for accuracy 
5.16 	and consistency with diagnostic assessment, treatment plan, and behavior goals and the 
5.17 	professional or practitioner must approve and sign the progress notes;
5.18 	(ii) identify changes in treatment strategies, revise the individual behavior plan, 
5.19 	and communicate treatment instructions and methodologies as appropriate to ensure 
5.20 	that treatment is implemented correctly;
5.21 	(iii) demonstrate family-friendly behaviors that support healthy collaboration among 
5.22 	the child, the child's family, and providers as treatment is planned and implemented;
5.23 	(iv) ensure that the mental health behavioral aide is able to effectively communicate 
5.24 	with the child, the child's family, and the provider; and
5.25 	(v) record the results of any evaluation and corrective actions taken to modify the 
5.26 	work of the mental health behavioral aide;
5.27 	(6) providing service delivery that implements the individual treatment plan and 
5.28 	meets the requirements under subdivision 9; and
5.29 	(7) individual treatment plan review. The review must determine the extent to which 
5.30 	the services have met the goals and objectives in the previous treatment plan. The review 
5.31 	must assess the client's progress and ensure that services and treatment goals continue to 
5.32 	be necessary and appropriate to the client and the client's family or foster family. Revision 
5.33 	of the individual treatment plan does not require a new diagnostic assessment unless the 
5.34 	client's mental health status has changed markedly. The updated treatment plan must be 
5.35 	signed by the client, if appropriate, and by the client's parent or other person authorized by 
5.36 	statute to give consent to the mental health services for the child.

6.1 	Sec. 5. Minnesota Statutes 2008, section 256B.0943, subdivision 9, is amended to read:
6.2 		Subd. 9.Service delivery criteria. (a) In delivering services under this section, a 
6.3 	certified provider entity must ensure that:
6.4 	(1) each individual provider's caseload size permits the provider to deliver services 
6.5 	to both clients with severe, complex needs and clients with less intensive needs. The 
6.6 	provider's caseload size should reasonably enable the provider to play an active role in 
6.7 	service planning, monitoring, and delivering services to meet the client's and client's 
6.8 	family's needs, as specified in each client's individual treatment plan;
6.9 	(2) site-based programs, including day treatment and preschool programs, provide 
6.10 	staffing and facilities to ensure the client's health, safety, and protection of rights, and that 
6.11 	the programs are able to implement each client's individual treatment plan;
6.12 	(3) a day treatment program is provided to a group of clients by a multidisciplinary 
6.13 	team under the clinical supervision of a mental health professional. The day treatment 
6.14 	program must be provided in and by: (i) an outpatient hospital accredited by the Joint 
6.15 	Commission on Accreditation of Health Organizations and licensed under sections 
6.16 	144.50 to 144.55; (ii) a community mental health center under section 245.62; and (iii) 
6.17 	an entity that is under contract with the county board to operate a program that meets 
6.18 	the requirements of sections 245.4712, subdivision 2, and 245.4884, subdivision 2, 
6.19 	and Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must 
6.20 	stabilize the client's mental health status while developing and improving the client's 
6.21 	independent living and socialization skills. The goal of the day treatment program must 
6.22 	be to reduce or relieve the effects of mental illness and provide training to enable the 
6.23 	client to live in the community. The program must be available at least one day a week 
6.24 	for a three-hour two-hour time block. The three-hour two-hour  time block must include 
6.25 	at least one hour, but no more than two hours, of individual or group psychotherapy. 
6.26 	The remainder of the three-hour time block may include recreation therapy, socialization 
6.27 	therapy, or independent living skills therapy, but only if the therapies are included in the 
6.28 	client's individual treatment plan The structured treatment program may include individual 
6.29 	or group psychotherapy and recreation therapy, socialization therapy, or independent 
6.30 	living skills therapy, if included in the client's individual treatment plan. Day treatment 
6.31 	programs are not part of inpatient or residential treatment services; and 
6.32 	(4) a preschool program is a structured treatment program offered to a child who 
6.33 	is at least 33 months old, but who has not yet reached the first day of kindergarten, by a 
6.34 	preschool multidisciplinary team in a day program licensed under Minnesota Rules, parts 
6.35 	9503.0005 to 9503.0175. The program must be available at least one day a week for a 
6.36 	minimum two-hour time block. The structured treatment program may include individual 
7.1 	or group psychotherapy and recreation therapy, socialization therapy, or independent 
7.2 	living skills therapy, if included in the client's individual treatment plan.
7.3 	(b) A provider entity must deliver the service components of children's therapeutic 
7.4 	services and supports in compliance with the following requirements:
7.5 	(1) individual, family, and group psychotherapy must be delivered as specified in 
7.6 	Minnesota Rules, part 9505.0323;
7.7 	(2) individual, family, or group skills training must be provided by a mental health 
7.8 	professional or a mental health practitioner who has a consulting relationship with a 
7.9 	mental health professional who accepts full professional responsibility for the training;
7.10 	(3) crisis assistance must be time-limited and designed to resolve or stabilize crisis 
7.11 	through arrangements for direct intervention and support services to the child and the 
7.12 	child's family. Crisis assistance must utilize resources designed to address abrupt or 
7.13 	substantial changes in the functioning of the child or the child's family as evidenced by 
7.14 	a sudden change in behavior with negative consequences for well being, a loss of usual 
7.15 	coping mechanisms, or the presentation of danger to self or others;
7.16 	(4) medically necessary services that are provided by a mental health behavioral 
7.17 	aide must be designed to improve the functioning of the child and support the family in 
7.18 	activities of daily and community living. A mental health behavioral aide must document 
7.19 	the delivery of services in written progress notes. The mental health behavioral aide 
7.20 	must implement goals in the treatment plan for the child's emotional disturbance that 
7.21 	allow the child to acquire developmentally and therapeutically appropriate daily living 
7.22 	skills, social skills, and leisure and recreational skills through targeted activities. These 
7.23 	activities may include:
7.24 	(i) assisting a child as needed with skills development in dressing, eating, and 
7.25 	toileting;
7.26 	(ii) assisting, monitoring, and guiding the child to complete tasks, including 
7.27 	facilitating the child's participation in medical appointments;
7.28 	(iii) observing the child and intervening to redirect the child's inappropriate behavior;
7.29 	(iv) assisting the child in using age-appropriate self-management skills as related 
7.30 	to the child's emotional disorder or mental illness, including problem solving, decision 
7.31 	making, communication, conflict resolution, anger management, social skills, and 
7.32 	recreational skills;
7.33 	(v) implementing deescalation techniques as recommended by the mental health 
7.34 	professional;
7.35 	(vi) implementing any other mental health service that the mental health professional 
7.36 	has approved as being within the scope of the behavioral aide's duties; or
8.1 	(vii) assisting the parents to develop and use parenting skills that help the child 
8.2 	achieve the goals outlined in the child's individual treatment plan or individual behavioral 
8.3 	plan. Parenting skills must be directed exclusively to the child's treatment; and
8.4 	(5) direction of a mental health behavioral aide must include the following:
8.5 	(i) a total of one hour of on-site observation by a mental health professional during 
8.6 	the first 12 hours of service provided to a child;
8.7 	(ii) ongoing on-site observation by a mental health professional or mental health 
8.8 	practitioner for at least a total of one hour during every 40 hours of service provided 
8.9 	to a child; and
8.10 	(iii) immediate accessibility of the mental health professional or mental health 
8.11 	practitioner to the mental health behavioral aide during service provision.