2006 Minnesota Statutes

256B.0622 INTENSIVE REHABILITATIVE MENTAL HEALTH SERVICES.
    Subdivision 1. Scope. Subject to federal approval, medical assistance covers medically
necessary, intensive nonresidential and residential rehabilitative mental health services as defined
in subdivision 2, for recipients as defined in subdivision 3, when the services are provided by an
entity meeting the standards in this section.
    Subd. 2. Definitions. For purposes of this section, the following terms have the meanings
given them.
(a) "Intensive nonresidential rehabilitative mental health services" means adult rehabilitative
mental health services as defined in section 256B.0623, subdivision 2, paragraph (a), except that
these services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, the Fairweather Lodge treatment model, as defined by the
standards established by the National Coalition for Community Living, and other evidence-based
practices, and directed to recipients with a serious mental illness who require intensive services.
(b) "Intensive residential rehabilitative mental health services" means short-term,
time-limited services provided in a residential setting to recipients who are in need of more
restrictive settings and are at risk of significant functional deterioration if they do not receive
these services. Services are designed to develop and enhance psychiatric stability, personal and
emotional adjustment, self-sufficiency, and skills to live in a more independent setting. Services
must be directed toward a targeted discharge date with specified client outcomes and must be
consistent with the Fairweather Lodge treatment model as defined in paragraph (a), and other
evidence-based practices.
(c) "Evidence-based practices" are nationally recognized mental health services that are
proven by substantial research to be effective in helping individuals with serious mental illness
obtain specific treatment goals.
(d) "Overnight staff" means a member of the intensive residential rehabilitative mental health
treatment team who is responsible during hours when recipients are typically asleep.
(e) "Treatment team" means all staff who provide services under this section to recipients.
At a minimum, this includes the clinical supervisor, mental health professionals, mental health
practitioners, and mental health rehabilitation workers.
    Subd. 3. Eligibility. An eligible recipient is an individual who:
(1) is age 18 or older;
(2) is eligible for medical assistance;
(3) is diagnosed with a mental illness;
(4) because of a mental illness, has substantial disability and functional impairment in
three or more of the areas listed in section 245.462, subdivision 11a, so that self-sufficiency
is markedly reduced;
(5) has one or more of the following: a history of two or more inpatient hospitalizations in
the past year, significant independent living instability, homelessness, or very frequent use of
mental health and related services yielding poor outcomes; and
(6) in the written opinion of a licensed mental health professional, has the need for mental
health services that cannot be met with other available community-based services, or is likely to
experience a mental health crisis or require a more restrictive setting if intensive rehabilitative
mental health services are not provided.
    Subd. 4. Provider certification and contract requirements. (a) The intensive nonresidential
rehabilitative mental health services provider must:
(1) have a contract with the host county to provide intensive adult rehabilitative mental
health services; and
(2) be certified by the commissioner as being in compliance with this section and section
256B.0623.
(b) The intensive residential rehabilitative mental health services provider must:
(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;
(2) not exceed 16 beds per site;
(3) comply with the additional standards in this section; and
(4) have a contract with the host county to provide these services.
(c) The commissioner shall develop procedures for counties and providers to submit
contracts and other documentation as needed to allow the commissioner to determine whether
the standards in this section are met.
    Subd. 5. Standards applicable to both nonresidential and residential providers. (a)
Services must be provided by qualified staff as defined in section 256B.0623, subdivision 5, who
are trained and supervised according to section 256B.0623, subdivision 6, except that mental
health rehabilitation workers acting as overnight staff are not required to comply with section
256B.0623, subdivision 5, clause (3)(iv).
(b) The clinical supervisor must be an active member of the treatment team. The treatment
team must meet with the clinical supervisor at least weekly to discuss recipients' progress and make
rapid adjustments to meet recipients' needs. The team meeting shall include recipient-specific case
reviews and general treatment discussions among team members. Recipient-specific case reviews
and planning must be documented in the individual recipient's treatment record.
(c) Treatment staff must have prompt access in person or by telephone to a mental health
practitioner or mental health professional. The provider must have the capacity to promptly and
appropriately respond to emergent needs and make any necessary staffing adjustments to assure
the health and safety of recipients.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every three months or prior to discharge from the service, whichever comes first.
(e) The initial individual treatment plan must be completed within ten days of intake and
reviewed and updated at least monthly with the recipient.
    Subd. 6. Standards for intensive residential rehabilitative mental health services. (a) The
provider of intensive residential services must have sufficient staff to provide 24-hour-per-day
coverage to deliver the rehabilitative services described in the treatment plan and to safely
supervise and direct the activities of recipients given the recipient's level of behavioral and
psychiatric stability, cultural needs, and vulnerability. The provider must have the capacity within
the facility to provide integrated services for chemical dependency, illness management services,
and family education when appropriate.
(b) At a minimum:
(1) staff must be available and provide direction and supervision whenever recipients are
present in the facility;
(2) staff must remain awake during all work hours;
(3) there must be a staffing ratio of at least one to nine recipients for each day and evening
shift. If more than nine recipients are present at the residential site, there must be a minimum
of two staff during day and evening shifts, one of whom must be a mental health practitioner or
mental health professional;
(4) if services are provided to recipients who need the services of a medical professional, the
provider shall assure that these services are provided either by the provider's own medical staff or
through referral to a medical professional; and
(5) the provider must assure the timely availability of a licensed registered nurse, either
directly employed or under contract, who is responsible for ensuring the effectiveness and safety
of medication administration in the facility and assessing patients for medication side effects
and drug interactions.
    Subd. 7. Additional standards for nonresidential services. The standards in this
subdivision apply to intensive nonresidential rehabilitative mental health services.
(1) The treatment team must use team treatment, not an individual treatment model.
(2) The clinical supervisor must function as a practicing clinician at least on a part-time basis.
(3) The staffing ratio must not exceed ten recipients to one full-time equivalent treatment
team position.
(4) Services must be available at times that meet client needs.
(5) The treatment team must actively and assertively engage and reach out to the recipient's
family members and significant others, after obtaining the recipient's permission.
(6) The treatment team must establish ongoing communication and collaboration between
the team, family, and significant others and educate the family and significant others about mental
illness, symptom management, and the family's role in treatment.
(7) The treatment team must provide interventions to promote positive interpersonal
relationships.
    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 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. In developing these rates, the host county shall consider
and document:
(1) the cost for similar services in the local trade area;
(2) actual costs incurred by entities providing the services;
(3) the intensity and frequency of services to be provided to each recipient;
(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).
    Subd. 9. Provider enrollment; rate setting for county-operated entities. Counties
that employ their own staff to provide services under this section shall apply directly to the
commissioner for enrollment and rate setting. In this case, a county contract is not required
and the commissioner shall perform the program review and rate setting duties which would
otherwise be required of counties under this section.
    Subd. 10. Provider enrollment; rate setting for specialized program. A provider
proposing to serve a subpopulation of eligible recipients may bypass the county approval
procedures in this section and receive approval for provider enrollment and rate setting directly
from the commissioner under the following circumstances:
(1) the provider demonstrates that the subpopulation to be served requires a specialized
program which is not available from county-approved entities; and
(2) the subpopulation to be served is of such a low incidence that it is not feasible to develop
a program serving a single county or regional group of counties.
For providers meeting the criteria in clauses (1) and (2), the commissioner shall perform
the program review and rate setting duties which would otherwise be required of counties under
this section.
History: 1Sp2003 c 14 art 3 s 19; 2004 c 288 art 3 s 23; 1Sp2005 c 4 art 2 s 7