1.1 	A bill for an act
1.2 	relating to human services; expanding reimbursement for mental health services;
1.3 	amending Minnesota Statutes 2004, sections 256B.0623, subdivision 8; 
1.4 	256B.0625, subdivision 43, by adding a subdivision; 256B.0943, subdivisions 
1.5 	1, 2, by adding a subdivision; 256B.761; Minnesota Statutes 2005 Supplement, 
1.6 	sections 256B.0625, subdivisions 38, 46; 256L.035; proposing coding for new 
1.7 	law in Minnesota Statutes, chapter 256B.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2004, section 256B.0623, subdivision 8, is amended to 
1.10 	read:
1.11 		Subd. 8.Diagnostic assessment. Providers of adult rehabilitative mental health 
1.12 	services must complete a diagnostic assessment as defined in section  245.462, subdivision 
1.13 	9, within five days after the recipient's second visit or within 30 days after intake, 
1.14 	whichever occurs first. A diagnostic assessment must be reimbursed at the same rate 
1.15 	as a diagnostic assessment under section 256B.49, subdivision 14. In cases where a 
1.16 	diagnostic assessment is available that reflects the recipient's current status, and has been 
1.17 	completed within 180 days preceding admission, an update must be completed. An 
1.18 	update shall include a written summary by a mental health professional of the recipient's 
1.19 	current mental health status and service needs. If the recipient's mental health status 
1.20 	has changed significantly since the adult's most recent diagnostic assessment, a new 
1.21 	diagnostic assessment is required. For initial implementation of adult rehabilitative mental 
1.22 	health services, until June 30, 2005, a diagnostic assessment that reflects the recipient's 
1.23 	current status and has been completed within the past three years preceding admission 
1.24 	is acceptable. 

2.1 	Sec. 2. Minnesota Statutes 2005 Supplement, section 256B.0625, subdivision 38, 
2.2 	is amended to read:
2.3 		Subd. 38.Payments for mental health services. (a) Payments for mental 
2.4 	health services covered under the medical assistance program that are provided by 
2.5 	masters-prepared mental health professionals shall be 80 percent of the rate paid to 
2.6 	doctoral-prepared professionals. Payments for mental health services covered under 
2.7 	the medical assistance program that are provided by masters-prepared mental health 
2.8 	professionals employed by community mental health centers shall be 100 percent of the 
2.9 	rate paid to doctoral-prepared professionals. For purposes of reimbursement of mental 
2.10 	health professionals under the medical assistance program, all 
2.11 	(b) Payments for mental health services covered under the medical assistance 
2.12 	program that are provided by social workers who:
2.13 	(1) have received a master's degree in social work from a program accredited by the 
2.14 	Council on Social Work Education;
2.15 	(2) are licensed at the level of graduate social worker or independent social worker; 
2.16 	and
2.17 	(3) are practicing clinical social work under appropriate supervision, as defined by 
2.18 	chapter 148D; and
2.19 	(4) meet all requirements under Minnesota Rules, part 9505.0323, subpart 24, and 
2.20 	shall be paid accordingly
2.21 	shall be paid in accordance with Minnesota Rules, part 9505.0323, subpart 24, unless 
2.22 	paragraph (c) is applicable.
2.23 	(c) Payments for mental health services covered under the medical assistance 
2.24 	program that are provided by an individual who is employed by a community health 
2.25 	center and who has completed all requirements for licensure or board certification as a 
2.26 	mental health professional except for the requirements for supervised experience in the 
2.27 	delivery of mental health services or by an individual who is a student in a bona fide field 
2.28 	placement or internship under a program leading to completion of the requirements for 
2.29 	licensure as a mental health professional shall be reimbursed at 100 percent of the rate 
2.30 	paid to a doctoral-prepared professional. The individual providing the service must be 
2.31 	under the clinical supervision of a fully qualified mental health professional. 
2.32 	(d) Medical assistance covers clinical supervision of unlicensed practitioners by a 
2.33 	mental health professional when clinical supervision is required as part of other medical 
2.34 	assistance services.

3.1 	Sec. 3. Minnesota Statutes 2004, section 256B.0625, subdivision 43, is amended to 
3.2 	read:
3.3 		Subd. 43.Mental health provider travel time. Medical assistance covers provider 
3.4 	travel time plus reimbursement for mileage if a recipient's individual treatment plan 
3.5 	requires the provision of mental health services outside of the provider's normal place of 
3.6 	business. This Reimbursement under this subdivision  does not include any travel time 
3.7 	which is included in other billable services, and is only covered when the mental health 
3.8 	service being provided to a recipient is covered under medical assistance.

3.9 	Sec. 4. Minnesota Statutes 2005 Supplement, section 256B.0625, subdivision 46, 
3.10 	is amended to read:
3.11 		Subd. 46.Mental health telemedicine. Effective January 1, 2006, and subject to 
3.12 	federal approval, mental health services that are otherwise covered by medical assistance 
3.13 	as direct face-to-face services may be provided via two-way interactive video. Use of 
3.14 	two-way interactive video must be medically appropriate to the condition and needs 
3.15 	of the person being served. Reimbursement is at the same rates and under the same 
3.16 	conditions that would otherwise apply to the service and shall include payment for the 
3.17 	originating facility fee and the cost of broadband connections. The interactive video 
3.18 	equipment and connection must comply with Medicare standards in effect at the time 
3.19 	the service is provided.

3.20 	Sec. 5. Minnesota Statutes 2004, section 256B.0625, is amended by adding a 
3.21 	subdivision to read:
3.22 		Subd. 5l.Intensive mental health outpatient treatment. Intensive outpatient 
3.23 	treatment is a concentrated, nonresidential, coordinated, structured, multimode treatment 
3.24 	and rehabilitative service that is at least two hours per day, and nine to 20 hours per 
3.25 	week, designed to address a mental disorder as indicated in the treatment plan. The 
3.26 	service provides an opportunity to combine existing covered services, in order to 
3.27 	deliver the necessary intensity and frequency of individual, family or multifamily group 
3.28 	psychotherapy, psycho-educational services, and adjunctive services such as medical 
3.29 	monitoring, family psycho-education, behavioral parent training, rehabilitative services, 
3.30 	medication education, relapse prevention, illness management and recovery services, 
3.31 	care coordination, and service coordination and referral arrangements for medical care 
3.32 	or social services necessary to support the individual treatment plan. During transition 
3.33 	into or from services, intensive outpatient treatment may include time-limited services in 
3.34 	multiple settings as clinically necessary. The service must be paid as a per diem based on 
4.1 	90 percent of the rate paid for partial hospitalization. Eligible providers must be licensed 
4.2 	or certified to provide all aspects of the service.

4.3 	Sec. 6. Minnesota Statutes 2004, section 256B.0943, subdivision 1, is amended to read:
4.4 		Subdivision 1.Definitions. For purposes of this section, the following terms have 
4.5 	the meanings given them.
4.6 	(a) "Children's therapeutic services and supports" means the flexible package of 
4.7 	mental health services for children who require varying therapeutic and rehabilitative 
4.8 	levels of intervention. The services are time-limited interventions that are delivered using 
4.9 	various treatment modalities and combinations of services designed to reach treatment 
4.10 	outcomes identified in the individual treatment plan.
4.11 	(b) "Clinical supervision" means the overall responsibility of the mental health 
4.12 	professional for the control and direction of individualized treatment planning, service 
4.13 	delivery, and treatment review for each client. A mental health professional who is an 
4.14 	enrolled Minnesota health care program provider accepts full professional responsibility 
4.15 	for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work, 
4.16 	and oversees or directs the supervisee's work.
4.17 	(c) "County board" means the county board of commissioners or board established 
4.18 	under sections  402.01 to  402.10 or  471.59. 
4.19 	(d) "Crisis assistance" has the meaning given in section  245.4871, subdivision 9a. 
4.20 	(e) "Culturally competent provider" means a provider who understands and can 
4.21 	utilize to a client's benefit the client's culture when providing services to the client. A 
4.22 	provider may be culturally competent because the provider is of the same cultural or 
4.23 	ethnic group as the client or the provider has developed the knowledge and skills through 
4.24 	training and experience to provide services to culturally diverse clients.
4.25 	(f) "Day treatment program" for children means a site-based structured program 
4.26 	consisting of group psychotherapy for more than three individuals and other intensive 
4.27 	therapeutic services provided by a multidisciplinary team, under the clinical supervision 
4.28 	of a mental health professional.
4.29 	(g) "Diagnostic assessment" has the meaning given in section  245.4871, subdivision 
4.30 	11. 
4.31 	(h) "Direct service time" means the time that a mental health professional, mental 
4.32 	health practitioner, or mental health behavioral aide spends face-to-face with a client 
4.33 	and the client's family. Direct service time includes time in which the provider obtains 
4.34 	a client's history or provides service components of children's therapeutic services and 
4.35 	supports. Direct service time does not include time doing work before and after providing 
5.1 	direct services, including scheduling, maintaining clinical records, consulting with others 
5.2 	about the client's mental health status, preparing reports, receiving clinical supervision 
5.3 	directly related to the client's psychotherapy session, and revising the client's individual 
5.4 	treatment plan.
5.5 	(i) "Direction of mental health behavioral aide" means the activities of a mental 
5.6 	health professional or mental health practitioner in guiding the mental health behavioral 
5.7 	aide in providing services to a client. The direction of a mental health behavioral aide 
5.8 	must be based on the client's individualized treatment plan and meet the requirements in 
5.9 	subdivision 6, paragraph (b), clause (5).
5.10 	(j) "Emotional disturbance" has the meaning given in section  245.4871, subdivision 
5.11 	15. For persons at least age 18 but under age 21, mental illness has the meaning given in 
5.12 	section  245.462, subdivision 20, paragraph (a). 
5.13 	(k) "Family psycho-education" is a multimodel outpatient therapy and rehabilitative 
5.14 	service that involves parents, families, and others as resources in the treatment, recovery, 
5.15 	and improved functioning of a person with mental illness or emotional disturbance, 
5.16 	in which families learn about the illness, family reactions, and types of treatment and 
5.17 	supports. Families learn to develop skills to handle problems posed by mental illness 
5.18 	including coping, managing stress, ensuring safety, creating social support, identifying 
5.19 	resources, and supporting treatment and recovery goals. Services include family 
5.20 	counseling, family treatment planning, and family support using cognitive, behavioral, 
5.21 	problem-solving, and communication strategies, and may involve individual, family, and 
5.22 	group intervention activities for consumers and families together, famlies-only, or brief or 
5.23 	intermittent consultations at critical times in an episode of care. Eligible providers must 
5.24 	be certified to provide both outpatient mental health services and rehabilitative services 
5.25 	under sections 256B.0623 and 256B.0943.
5.26 	(k) (l) "Individual behavioral plan" means a plan of intervention, treatment, and 
5.27 	services for a child written by a mental health professional or mental health practitioner, 
5.28 	under the clinical supervision of a mental health professional, to guide the work of the 
5.29 	mental health behavioral aide.
5.30 	(l) (m) "Individual treatment plan" has the meaning given in section  245.4871, 
5.31 	subdivision 21. 
5.32 	(m) (n) "Mental health professional" means an individual as defined in section  
5.33 	245.4871, subdivision 27, clauses (1) to (5), or tribal vendor as defined in section  256B.02, 
5.34 	subdivision 7, paragraph (b). 
5.35 	(n) (o) "Preschool program" means a day program licensed under Minnesota Rules, 
5.36 	parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and 
6.1 	supports provider to provide a structured treatment program to a child who is at least 33 
6.2 	months old but who has not yet attended the first day of kindergarten.
6.3 	(o) (p) "Skills training" means individual, family, or group training designed to 
6.4 	improve the basic functioning of the child with emotional disturbance and the child's 
6.5 	family in the activities of daily living and community living, and to improve the social 
6.6 	functioning of the child and the child's family in areas important to the child's maintaining 
6.7 	or reestablishing residency in the community. Skills training must also be provided to the 
6.8 	parent, guardian, or caregiver of a child without the child present. Individual, family, 
6.9 	and group skills training must:
6.10 	(1) consist of activities designed to promote skill development of the child and the 
6.11 	child's family in the use of age-appropriate daily living skills, interpersonal and family 
6.12 	relationships, and leisure and recreational services;
6.13 	(2) consist of activities that will assist the family's understanding of normal child 
6.14 	development and to use parenting skills that will help the child with emotional disturbance 
6.15 	achieve the goals outlined in the child's individual treatment plan; and
6.16 	(3) promote family preservation and unification, promote the family's integration 
6.17 	with the community, and reduce the use of unnecessary out-of-home placement or 
6.18 	institutionalization of children with emotional disturbance.

6.19 	Sec. 7. Minnesota Statutes 2004, section 256B.0943, subdivision 2, is amended to read:
6.20 		Subd. 2.Covered service components of children's therapeutic services and 
6.21 	supports. (a) Subject to federal approval, medical assistance covers medically necessary 
6.22 	children's therapeutic services and supports as defined in this section that an eligible 
6.23 	provider entity under subdivisions 4 and 5 provides to a client eligible under subdivision 3.
6.24 	(b) The service components of children's therapeutic services and supports are:
6.25 	(1) individual, family, and group psychotherapy, and family psycho-education;
6.26 	(2) individual, family, or group skills training provided by a mental health 
6.27 	professional or mental health practitioner;
6.28 	(3) crisis assistance;
6.29 	(4) mental health behavioral aide services; and
6.30 	(5) direction of a mental health behavioral aide.
6.31 	(c) Service components may be combined to constitute therapeutic programs, 
6.32 	including day treatment programs and preschool programs. Although day treatment and 
6.33 	preschool programs have specific client and provider eligibility requirements, medical 
6.34 	assistance only pays for the service components listed in paragraph (b).

7.1 	Sec. 8. Minnesota Statutes 2004, section 256B.0943, is amended by adding a 
7.2 	subdivision to read:
7.3 		Subd. 11a.Reimbursement of diagnostic assessments. A diagnostic assessment 
7.4 	under this section must be reimbursed at the same rate as a diagnostic assessment under 
7.5 	section 256B.49, subdivision 14.

7.6 	Sec. 9. Minnesota Statutes 2004, section 256B.761, is amended to read:
7.7 	256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
7.8 	(a) Effective for services rendered on or after July 1, 2001, payment for medication 
7.9 	management provided to psychiatric patients, outpatient mental health services, day 
7.10 	treatment services, home-based mental health services, and family community support 
7.11 	services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 
7.12 	50th percentile of 1999 charges.
7.13 	(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health 
7.14 	services provided by an entity that operates: (1) a Medicare-certified comprehensive 
7.15 	outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 
7.16 	1993, with at least 33 percent of the clients receiving rehabilitation services in the most 
7.17 	recent calendar year who are medical assistance recipients, will be increased by 38 percent, 
7.18 	when those services are provided within the comprehensive outpatient rehabilitation 
7.19 	facility and provided to residents of nursing facilities owned by the entity.
7.20 	(c) Notwithstanding section 256B.03, subdivision 1, effective July 1, 2006, the 
7.21 	medical assistance payment rates for mental health services provided by mental health 
7.22 	professionals shall be determined by using the average usual and customary charge of 
7.23 	the doctoral prepared professionals only. 

7.24 	Sec. 10. [256B.763] MENTAL HEALTH CENTERS AND CLINICS 
7.25 	REIMBURSEMENT.
7.26 	 (a) Effective for services rendered on or after July 1, 2006, payment rates for:  (1) 
7.27 	community mental health center services under section 256B.0625, subdivision 5; and (2) 
7.28 	services provided by mental health clinics and centers certified under Minnesota Rules, 
7.29 	parts 9520.0750 to 9520.0870, or hospital outpatient psychiatric departments that are 
7.30 	designated as essential community providers under section 62Q.19, shall be increased by 
7.31 	20 percent over the rates in effect on January 1, 2005.  This increase does not apply to 
7.32 	services with rates negotiated with the county or that received increases between January 
7.33 	1, 2005, and January 1, 2006.  This reimbursement increase shall be in addition to any 
7.34 	other reimbursement increases enacted by the 2006 legislature.
8.1 	 (b) The commissioner shall adjust rates paid to prepaid health plans under contract 
8.2 	with the commissioner to reflect the rate increases provided in paragraph (a) effective for 
8.3 	services rendered on or after January 1, 2007.  The prepaid health plan must pass this rate 
8.4 	increase to the providers identified in paragraph (a).

8.5 	Sec. 11. Minnesota Statutes 2005 Supplement, section 256L.035, is amended to read:
8.6 	256L.035 LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE 
8.7 	ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.
8.8 	(a) "Covered health services" for individuals under section 256L.04, subdivision 
8.9 	7, with income above 75 percent, but not exceeding 175 percent, of the federal poverty 
8.10 	guideline means:
8.11 	(1) inpatient hospitalization benefits with a ten percent co-payment up to $1,000 and 
8.12 	subject to an annual limitation of $10,000;
8.13 	(2) physician services provided during an inpatient stay; and
8.14 	(3) physician services not provided during an inpatient stay; outpatient hospital 
8.15 	services; freestanding ambulatory surgical center services; chiropractic services; lab and 
8.16 	diagnostic services; diabetic supplies and equipment; outpatient mental health services, 
8.17 	as defined under section 256L.03, subdivision 1; and prescription drugs; subject to the 
8.18 	following co-payments:
8.19 	(i) $50 co-pay per emergency room visit;
8.20 	(ii) $3 co-pay per prescription drug; and
8.21 	(iii) $5 co-pay per nonpreventive visit.
8.22 	The services covered under this section may be provided by a physician, physician 
8.23 	ancillary, chiropractor, psychologist, or licensed independent clinical social worker or a 
8.24 	mental health professional, as defined under section 256B.0625, subdivision 42, if the 
8.25 	services are within the scope of practice of that health care professional.
8.26 	For purposes of this section, "a visit" means an episode of service which is required 
8.27 	because of a recipient's symptoms, diagnosis, or established illness, and which is delivered 
8.28 	in an ambulatory setting by any health care provider identified in this paragraph.
8.29 	Enrollees are responsible for all co-payments in this section.
8.30 	(b) Reimbursement to the providers shall be reduced by the amount of the 
8.31 	co-payment, except that reimbursement for prescription drugs shall not be reduced once a 
8.32 	recipient has reached the $20 per month maximum for prescription drug co-payments. 
8.33 	The provider collects the co-payment from the recipient. Providers may not deny services 
8.34 	to recipients who are unable to pay the co-payment, except as provided in paragraph (c).
9.1 	(c) If it is the routine business practice of a provider to refuse service to an individual 
9.2 	with uncollected debt, the provider may include uncollected co-payments under this 
9.3 	section. A provider must give advance notice to a recipient with uncollected debt before 
9.4 	services can be denied.