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Minnesota Legislature

Office of the Revisor of Statutes

Chapter 245

Section 245.462

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245.462 DEFINITIONS.
    Subdivision 1. Definitions. The definitions in this section apply to sections 245.461 to
245.486.
    Subd. 2. Acute care hospital inpatient treatment. "Acute care hospital inpatient treatment"
means short-term medical, nursing, and psychosocial services provided in an acute care hospital
licensed under chapter 144.
    Subd. 3. Case management services. "Case management services" means activities that
are coordinated with the community support services program as defined in subdivision 6 and
are designed to help adults with serious and persistent mental illness in gaining access to
needed medical, social, educational, vocational, and other necessary services as they relate to
the client's mental health needs. Case management services include developing a functional
assessment, an individual community support plan, referring and assisting the person to obtain
needed mental health and other services, ensuring coordination of services, and monitoring the
delivery of services.
    Subd. 4. Case management service provider. (a) "Case management service provider"
means a case manager or case manager associate employed by the county or other entity authorized
by the county board to provide case management services specified in section 245.4711.
(b) A case manager must:
(1) be skilled in the process of identifying and assessing a wide range of client needs;
(2) be knowledgeable about local community resources and how to use those resources
for the benefit of the client;
(3) have a bachelor's degree in one of the behavioral sciences or related fields including, but
not limited to, social work, psychology, or nursing from an accredited college or university or
meet the requirements of paragraph (c); and
(4) meet the supervision and continuing education requirements described in paragraphs (d),
(e), and (f), as applicable.
(c) Case managers without a bachelor's degree must meet one of the requirements in clauses
(1) to (3):
(1) have three or four years of experience as a case manager associate as defined in this
section;
(2) be a registered nurse without a bachelor's degree and have a combination of specialized
training in psychiatry and work experience consisting of community interaction and involvement
or community discharge planning in a mental health setting totaling three years; or
(3) be a person who qualified as a case manager under the 1998 Department of Human
Service waiver provision and meet the continuing education and mentoring requirements in
this section.
(d) A case manager with at least 2,000 hours of supervised experience in the delivery of
services to adults with mental illness must receive regular ongoing supervision and clinical
supervision totaling 38 hours per year of which at least one hour per month must be clinical
supervision regarding individual service delivery with a case management supervisor. The
remaining 26 hours of supervision may be provided by a case manager with two years of
experience. Group supervision may not constitute more than one-half of the required supervision
hours. Clinical supervision must be documented in the client record.
(e) A case manager without 2,000 hours of supervised experience in the delivery of services
to adults with mental illness must:
(1) receive clinical supervision regarding individual service delivery from a mental health
professional at least one hour per week until the requirement of 2,000 hours of experience
is met; and
(2) complete 40 hours of training approved by the commissioner in case management skills
and the characteristics and needs of adults with serious and persistent mental illness.
(f) A case manager who is not licensed, registered, or certified by a health-related licensing
board must receive 30 hours of continuing education and training in mental illness and mental
health services every two years.
(g) A case manager associate (CMA) must:
(1) work under the direction of a case manager or case management supervisor;
(2) be at least 21 years of age;
(3) have at least a high school diploma or its equivalent; and
(4) meet one of the following criteria:
(i) have an associate of arts degree in one of the behavioral sciences or human services;
(ii) be a registered nurse without a bachelor's degree;
(iii) within the previous ten years, have three years of life experience with serious and
persistent mental illness as defined in section 245.462, subdivision 20; or as a child had severe
emotional disturbance as defined in section 245.4871, subdivision 6; or have three years life
experience as a primary caregiver to an adult with serious and persistent mental illness within
the previous ten years;
(iv) have 6,000 hours work experience as a nondegreed state hospital technician; or
(v) be a mental health practitioner as defined in section 245.462, subdivision 17, clause (2).
Individuals meeting one of the criteria in items (i) to (iv), may qualify as a case manager
after four years of supervised work experience as a case manager associate. Individuals meeting
the criteria in item (v), may qualify as a case manager after three years of supervised experience
as a case manager associate.
(h) A case management associate must meet the following supervision, mentoring, and
continuing education requirements:
(1) have 40 hours of preservice training described under paragraph (e), clause (2);
(2) receive at least 40 hours of continuing education in mental illness and mental health
services annually; and
(3) receive at least five hours of mentoring per week from a case management mentor.
A "case management mentor" means a qualified, practicing case manager or case management
supervisor who teaches or advises and provides intensive training and clinical supervision to
one or more case manager associates. Mentoring may occur while providing direct services to
consumers in the office or in the field and may be provided to individuals or groups of case
manager associates. At least two mentoring hours per week must be individual and face-to-face.
(i) A case management supervisor must meet the criteria for mental health professionals, as
specified in section 245.462, subdivision 18.
(j) An immigrant who does not have the qualifications specified in this subdivision may
provide case management services to adult immigrants with serious and persistent mental illness
who are members of the same ethnic group as the case manager if the person:
(1) is currently enrolled in and is actively pursuing credits toward the completion of a
bachelor's degree in one of the behavioral sciences or a related field including, but not limited to,
social work, psychology, or nursing from an accredited college or university;
(2) completes 40 hours of training as specified in this subdivision; and
(3) receives clinical supervision at least once a week until the requirements of this
subdivision are met.
    Subd. 4a. Clinical supervision. "Clinical supervision" means the oversight responsibility for
individual treatment plans and individual mental health service delivery, including that provided
by the case manager. Clinical supervision must be accomplished by full or part-time employment
of or contracts with mental health professionals. Clinical supervision must be documented by
the mental health professional cosigning individual treatment plans and by entries in the client's
record regarding supervisory activities.
    Subd. 5. Commissioner. "Commissioner" means the commissioner of human services.
    Subd. 6. Community support services program. "Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the clinical supervision of a mental health professional
designed to help adults with serious and persistent mental illness to function and remain in the
community. A community support services program includes:
(1) client outreach,
(2) medication monitoring,
(3) assistance in independent living skills,
(4) development of employability and work-related opportunities,
(5) crisis assistance,
(6) psychosocial rehabilitation,
(7) help in applying for government benefits, and
(8) housing support services.
The community support services program must be coordinated with the case management
services specified in section 245.4711.
    Subd. 7. County board. "County board" means the county board of commissioners or
board established pursuant to the Joint Powers Act, section 471.59, or the Human Services Act,
sections 402.01 to 402.10.
    Subd. 8. Day treatment services. "Day treatment," "day treatment services," or "day
treatment program" means a structured program of treatment and care provided to an adult in
or by: (1) a hospital accredited by the joint commission on accreditation of health organizations
and licensed under sections 144.50 to 144.55; (2) a community mental health center under
section 245.62; or (3) an entity that is under contract with the county board to operate a program
that meets the requirements of section 245.4712, subdivision 2, and Minnesota Rules, parts
9505.0170 to 9505.0475. Day treatment consists of group psychotherapy and other intensive
therapeutic services that are provided at least one day a week by a multidisciplinary staff under
the clinical supervision of a mental health professional. Day treatment may include education
and consultation provided to families and other individuals as part of the treatment process.
The services are aimed at stabilizing the adult's mental health status, providing mental health
services, and developing and improving the adult's independent living and socialization skills.
The goal of day treatment is to reduce or relieve mental illness and to enable the adult to live in
the community. Day treatment services are not a part of inpatient or residential treatment services.
Day treatment services are distinguished from day care by their structured therapeutic program of
psychotherapy services. The commissioner may limit medical assistance reimbursement for day
treatment to 15 hours per week per person instead of the three hours per day per person specified
in Minnesota Rules, part 9505.0323, subpart 15.
    Subd. 9. Diagnostic assessment. "Diagnostic assessment" means a written summary of
the history, diagnosis, strengths, vulnerabilities, and general service needs of an adult with a
mental illness using diagnostic, interview, and other relevant mental health techniques provided
by a mental health professional used in developing an individual treatment plan or individual
community support plan.
    Subd. 10. Education and prevention services. "Education and prevention services" means
services designed to educate the general public or special high-risk target populations about
mental illness, to increase the understanding and acceptance of problems associated with mental
illness, to increase people's awareness of the availability of resources and services, and to improve
people's skills in dealing with high-risk situations known to affect people's mental health and
functioning. The services include the distribution of information to individuals and agencies
identified by the county board and the local mental health advisory council, on predictors and
symptoms of mental disorders, where mental health services are available in the county, and
how to access the services.
    Subd. 11. Emergency services. "Emergency services" means an immediate response service
available on a 24-hour, seven-day-a-week basis for persons having a psychiatric crisis, a mental
health crisis, or emergency.
    Subd. 11a. Functional assessment. "Functional assessment" means an assessment by the
case manager of the adult's:
(1) mental health symptoms as presented in the adult's diagnostic assessment;
(2) mental health needs as presented in the adult's diagnostic assessment;
(3) use of drugs and alcohol;
(4) vocational and educational functioning;
(5) social functioning, including the use of leisure time;
(6) interpersonal functioning, including relationships with the adult's family;
(7) self-care and independent living capacity;
(8) medical and dental health;
(9) financial assistance needs;
(10) housing and transportation needs; and
(11) other needs and problems.
    Subd. 12. Individual community support plan. "Individual community support plan"
means a written plan developed by a case manager on the basis of a diagnostic assessment and
functional assessment. The plan identifies specific services needed by an adult with serious
and persistent mental illness to develop independence or improved functioning in daily living,
health and medication management, social functioning, interpersonal relationships, financial
management, housing, transportation, and employment.
    Subd. 13. Individual placement agreement. "Individual placement agreement" means a
written agreement or supplement to a service contract entered into between the county board and
a service provider on behalf of an individual adult to provide residential treatment services.
    Subd. 14. Individual treatment plan. "Individual treatment plan" means a written plan
of intervention, treatment, and services for an adult with mental illness that is developed by a
service provider under the clinical supervision of a mental health professional on the basis of a
diagnostic assessment. The plan identifies goals and objectives of treatment, treatment strategy, a
schedule for accomplishing treatment goals and objectives, and the individual responsible for
providing treatment to the adult with mental illness.
    Subd. 14c. Mental health crisis services. "Mental health crisis services" means crisis
assessment, crisis intervention, and crisis stabilization services.
    Subd. 15.[Repealed, 1991 c 94 s 25]
    Subd. 16. Mental health funds. "Mental health funds" are funds expended under sections
245.73 and 256E.12, federal mental health block grant funds, and funds expended under section
256D.06 to facilities licensed under Minnesota Rules, parts 9520.0500 to 9520.0690.
    Subd. 17. Mental health practitioner. "Mental health practitioner" means a person providing
services to persons with mental illness who is 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 services to persons
with mental illness; 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
persons with mental illness, 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 services to persons
with mental illness;
(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 mental illness.
    Subd. 18. Mental health professional. "Mental health professional" means a person
providing clinical services in the treatment of mental illness who is qualified in at least one of
the following ways:
(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171 to
148.285; and:
(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or
(ii) who has a master's degree in nursing or one of the behavioral sciences or related fields
from an accredited college or university or its equivalent, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness;
(2) in clinical social work: a person licensed as an independent clinical social worker under
chapter 148D, or a person with a master's degree in social work from an accredited college or
university, with at least 4,000 hours of post-master's supervised experience in the delivery of
clinical services in the treatment of mental illness;
(3) in psychology: an individual licensed by the Board of Psychology under sections 148.88
to 148.98 who has stated to the Board of Psychology competencies in the diagnosis and treatment
of mental illness;
(4) in psychiatry: a physician licensed under chapter 147 and certified by the American
Board of Psychiatry and Neurology or eligible for board certification in psychiatry;
(5) in marriage and family therapy: the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of mental
illness; or
(6) in allied fields: a person with a master's degree from an accredited college or university
in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness.
    Subd. 19. Mental health services. "Mental health services" means at least all of the
treatment services and case management activities that are provided to adults with mental illness
and are described in sections 245.461 to 245.486.
    Subd. 20. Mental illness. (a) "Mental illness" means an organic disorder of the brain or a
clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that
is listed in the clinical manual of the International Classification of Diseases (ICD-9-CM), current
edition, code range 290.0 to 302.99 or 306.0 to 316.0 or the corresponding code in the American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-MD),
current edition, Axes I, II, or III, and that seriously limits a person's capacity to function in primary
aspects of daily living such as personal relations, living arrangements, work, and recreation.
(b) An "adult with acute mental illness" means an adult who has a mental illness that is
serious enough to require prompt intervention.
(c) For purposes of case management and community support services, a "person with
serious and persistent mental illness" means an adult who has a mental illness and meets at
least one of the following criteria:
(1) the adult has undergone two or more episodes of inpatient care for a mental illness within
the preceding 24 months;
(2) the adult has experienced a continuous psychiatric hospitalization or residential treatment
exceeding six months' duration within the preceding 12 months;
(3) the adult:
(i) has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline
personality disorder;
(ii) indicates a significant impairment in functioning; and
(iii) has a written opinion from a mental health professional, in the last three years, stating
that the adult is reasonably likely to have future episodes requiring inpatient or residential
treatment, of a frequency described in clause (1) or (2), unless ongoing case management or
community support services are provided;
(4) the adult has, in the last three years, been committed by a court as a person who is
mentally ill under chapter 253B, or the adult's commitment has been stayed or continued; or
(5) the adult (i) was eligible under clauses (1) to (4), but the specified time period has
expired or the adult was eligible as a child under section 245.4871, subdivision 6; and (ii) has a
written opinion from a mental health professional, in the last three years, stating that the adult
is reasonably likely to have future episodes requiring inpatient or residential treatment, of a
frequency described in clause (1) or (2), unless ongoing case management or community support
services are provided.
    Subd. 21. Outpatient services. "Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under the
clinical supervision of a mental health professional to adults with mental illness who live outside
a hospital. Outpatient services include clinical activities such as individual, group, and family
therapy; individual treatment planning; diagnostic assessments; medication management; and
psychological testing.
    Subd. 22. Regional treatment center inpatient services. "Regional treatment center
inpatient services" means the 24-hour-a-day comprehensive medical, nursing, or psychosocial
services provided in a regional treatment center operated by the state.
    Subd. 23. Residential treatment. "Residential treatment" means a 24-hour-a-day program
under the clinical supervision of a mental health professional, in a community residential setting
other than an acute care hospital or regional treatment center inpatient unit, that must be licensed
as a residential treatment program for adults with mental illness under Minnesota Rules, parts
9520.0500 to 9520.0690 or other rules adopted by the commissioner.
    Subd. 24. Service provider. "Service provider" means either a county board or an individual
or agency including a regional treatment center under contract with the county board that provides
adult mental health services funded by sections 245.461 to 245.486.
    Subd. 25.[Repealed, 1989 c 282 art 4 s 64]
    Subd. 26. Significant impairment in functioning. "Significant impairment in functioning"
means a condition, including significant suicidal ideation or thoughts of harming self or others,
which harmfully affects, recurrently or consistently, a person's activities of daily living in
employment, housing, family and social relationships, or education.
History: 1987 c 403 art 2 s 17; 1988 c 689 art 2 s 64-73; 1989 c 282 art 4 s 2; 1990 c 426
art 2 s 6; 1990 c 568 art 5 s 34; 1991 c 292 art 6 s 3,4; 1992 c 526 s 1; 1Sp1993 c 1 art 7 s 2,3;
1996 c 451 art 5 s 4; 1997 c 7 art 1 s 94; 1998 c 407 art 4 s 2,3; 1999 c 86 art 1 s 55; 1999 c 172
s 15; 1999 c 245 art 5 s 2,3; 2000 c 474 s 3; 1Sp2001 c 9 art 9 s 5-8; 2002 c 221 s 15; 2002 c 375
art 2 s 5; 2002 c 379 art 1 s 113; 2004 c 288 art 3 s 7; 2005 c 147 art 1 s 65