1.1                          A bill for an act 
  1.2             relating to human services; providing services to 
  1.3             young adults for transitional services; increasing 
  1.4             community-based mental health services; amending 
  1.5             Minnesota Statutes 2000, sections 245.4886, 
  1.6             subdivision 1; 245.99, subdivision 4; 253.28, by 
  1.7             adding a subdivision; and 256B.0625, subdivision 20, 
  1.8             and by adding a subdivision; proposing coding for new 
  1.9             law in Minnesota Statutes, chapters 245; and 256B. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 2000, section 245.4886, 
  1.12  subdivision 1, is amended to read: 
  1.13     Subdivision 1.  [STATEWIDE PROGRAM; ESTABLISHMENT.] The 
  1.14  commissioner shall establish a statewide program to assist 
  1.15  counties in providing services to children with severe emotional 
  1.16  disturbance as defined in section 245.4871, subdivision 15, and 
  1.17  their families; and to young adults meeting the criteria for 
  1.18  transition services in section 245.4875, subdivision 8, and 
  1.19  their families.  Services must be designed to help each child to 
  1.20  function and remain with the child's family in the community.  
  1.21  Transition services to eligible young adults must be designed to 
  1.22  foster independent living in the community.  The commissioner 
  1.23  shall make grants to counties to establish, operate, or contract 
  1.24  with private providers to provide the following services in the 
  1.25  following order of priority when these cannot be reimbursed 
  1.26  under section 256B.0625: 
  1.27     (1) family community support services including crisis 
  2.1   placement and crisis respite care as specified in section 
  2.2   245.4871, subdivision 17; 
  2.3      (2) case management services as specified in section 
  2.4   245.4871, subdivision 3; 
  2.5      (3) day treatment services as specified in section 
  2.6   245.4871, subdivision 10; 
  2.7      (4) professional home-based family treatment as specified 
  2.8   in section 245.4871, subdivision 31; and 
  2.9      (5) therapeutic support of foster care as specified in 
  2.10  section 245.4871, subdivision 34. 
  2.11     Funding appropriated beginning July 1, 1991, must be used 
  2.12  by county boards to provide family community support services 
  2.13  and case management services.  Additional services shall be 
  2.14  provided in the order of priority as identified in this 
  2.15  subdivision. 
  2.16     Sec. 2.  [245.699] [AMERICAN INDIAN MENTAL HEALTH ADVISORY 
  2.17  COUNCIL.] 
  2.18     The commissioner shall appoint an American Indian mental 
  2.19  health advisory council to help formulate policies and 
  2.20  procedures relating to Indian mental health services and 
  2.21  programs and to make recommendations regarding approval of 
  2.22  grants provided under section 245.713, subdivision 2.  The 
  2.23  council shall consist of 15 members appointed by the 
  2.24  commissioner and must include representatives who are authorized 
  2.25  by tribal resolution from each of the 11 Minnesota reservations; 
  2.26  one representative from the Duluth urban Indian community; two 
  2.27  from the Minneapolis urban Indian community, and one from the St.
  2.28  Paul urban Indian community.  Representatives from the urban 
  2.29  Indian communities must be selected through an open appointments 
  2.30  process under section 15.059.  The terms, compensation, and 
  2.31  removal of American Indian mental health advisory council 
  2.32  members shall be as provided in section 15.059.  This council 
  2.33  does not expire until specifically repealed by the legislature. 
  2.34     Sec. 3.  Minnesota Statutes 2000, section 245.99, 
  2.35  subdivision 4, is amended to read: 
  2.36     Subd. 4.  [ADMINISTRATION OF CRISIS HOUSING ASSISTANCE.] 
  3.1   The commissioner may contract with organizations or government 
  3.2   units experienced in housing assistance to operate the program 
  3.3   under this section.  This program is not an entitlement.  The 
  3.4   commissioner may take any of the following steps whenever the 
  3.5   commissioner projects that funds will be inadequate to meet 
  3.6   demand in a given fiscal year: 
  3.7      (1) transfer funds from other grants in the same 
  3.8   appropriation; and 
  3.9      (2) impose statewide restrictions as to the type and amount 
  3.10  of assistance available to each recipient under this program. 
  3.11     Sec. 4.  Minnesota Statutes 2000, section 253.28, is 
  3.12  amended by adding a subdivision to read: 
  3.13     Subd. 1a.  [STATE-OPERATED SERVICES 
  3.14  AUTHORIZATION.] According to section 246.0136, the commissioner 
  3.15  of human services is authorized to implement, as an enterprise 
  3.16  activity, state-operated adult mental health services developed 
  3.17  for the purposes of preventing inpatient hospitalization or 
  3.18  facilitating the transition from hospital to community 
  3.19  placement, that qualify under the standards for adult mental 
  3.20  health rehabilitative services in section 256B.0623 and adult 
  3.21  mental health crisis response services in section 256B.0624, 
  3.22  once those options are incorporated as part of the approved 
  3.23  state medical assistance plan. 
  3.24     Sec. 5.  [256B.0623] [ADULT REHABILITATIVE MENTAL HEALTH 
  3.25  SERVICES.] 
  3.26     Subdivision 1.  [SCOPE.] Medical assistance covers adult 
  3.27  rehabilitative mental health services as defined in subdivision 
  3.28  2, subject to federal approval, if provided to recipients as 
  3.29  defined in subdivision 3 and provided by a qualified provider 
  3.30  entity meeting the standards in this section and by a qualified 
  3.31  individual provider working within the provider's scope of 
  3.32  practice and identified in the recipient's individual treatment 
  3.33  plan as defined in section 245.462, subdivision 14, and if 
  3.34  determined to be medically necessary. 
  3.35     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  3.36  following terms have the meanings given them. 
  4.1      (a) "Adult rehabilitative mental health services" means 
  4.2   mental health services which are rehabilitative and enable the 
  4.3   recipient to develop and enhance psychiatric stability, social 
  4.4   competencies, personal and emotional adjustment, and independent 
  4.5   living and community skills, when these abilities are impaired 
  4.6   by the symptoms of mental illness.  Adult rehabilitative mental 
  4.7   health services are appropriate when provided to enable a 
  4.8   recipient to retain stability and functioning, if the recipient 
  4.9   would be at risk of significant functional decompensation or 
  4.10  more restrictive service settings without these services. 
  4.11     (1) Adult rehabilitative mental health services instruct, 
  4.12  assist, and support the recipient in areas such as:  
  4.13  interpersonal communication skills, community resource 
  4.14  utilization and integration skills, crisis assistance and mental 
  4.15  health care directives, budgeting and shopping skills, healthy 
  4.16  lifestyle skills and practices, cooking and nutrition skills, 
  4.17  transportation skills, medication education and monitoring, 
  4.18  mental illness symptom management skills, household management 
  4.19  skills, employment-related skills, and transition to community 
  4.20  living services. 
  4.21     (2) These services shall be provided to the recipient on a 
  4.22  one-to-one basis in the recipient's home or another community 
  4.23  setting or in groups. 
  4.24     (b) "Medication education services" means services provided 
  4.25  individually or in groups which focus on educating the recipient 
  4.26  about mental illness and symptoms; the role and effects of 
  4.27  medications in treating symptoms of mental illness; and the side 
  4.28  effects of medications.  Medication education is coordinated 
  4.29  with medication management services, and does not duplicate it.  
  4.30  Medication education services are provided by physicians, 
  4.31  pharmacists, or registered nurses. 
  4.32     (c) "Transition to community living services" means 
  4.33  services which operationalize the discharge of the recipient 
  4.34  from a hospital, residential treatment program under Minnesota 
  4.35  Rules, chapter 9505, board and lodging facility, or nursing home.
  4.36  Transition to community living services are not intended to 
  5.1   provide other areas of adult rehabilitative mental health 
  5.2   services, but rather to focus on maintaining continuity of 
  5.3   contact with the recipient, and to evaluate and participate in 
  5.4   discharge planning from the supervised residential setting. 
  5.5      Subd. 3.  [ELIGIBILITY.] An eligible recipient who: 
  5.6      (1) is age 18 or older; 
  5.7      (2) is diagnosed with a medical condition, such as mental 
  5.8   illness or traumatic brain injury, for which adult 
  5.9   rehabilitative mental health services are needed; 
  5.10     (3) has substantial disability and functional impairment in 
  5.11  three or more primary aspects of daily living so that 
  5.12  self-sufficiency is markedly reduced; and 
  5.13     (4) has had a recent diagnostic assessment by a qualified 
  5.14  professional that documents adult rehabilitative mental health 
  5.15  services are medically necessary to address identified 
  5.16  disability and functional impairments and individual recipient 
  5.17  goals. 
  5.18     Subd. 4.  [PROVIDER ENTITY STANDARDS.] (a) The provider 
  5.19  entity must be: 
  5.20     (1) a county operated entity certified by the state; or 
  5.21     (2) a noncounty entity certified by the entity's host 
  5.22  county. 
  5.23     (b) The certification process is a determination as to 
  5.24  whether the entity meets the standards in this subdivision.  The 
  5.25  certification must specify which adult rehabilitative mental 
  5.26  health services the entity is qualified to provide. 
  5.27     (c) If an entity seeks to provide services outside its host 
  5.28  county, it must obtain additional certification from each county 
  5.29  in which it will provide services.  The additional certification 
  5.30  must be based on the adequacy of the entity's knowledge of that 
  5.31  county's local health and human service system, and the ability 
  5.32  of the entity to coordinate its services with the other services 
  5.33  available in that county. 
  5.34     (d) Recertification must occur at least every two years. 
  5.35     (e) The commissioner may intervene at any time and 
  5.36  decertify providers with cause.  The decertification is subject 
  6.1   to appeal to the state.  A county board may recommend with cause 
  6.2   that the state decertify a provider. 
  6.3      (f) The adult rehabilitative mental health services 
  6.4   provider entity must meet the following standards: 
  6.5      (1) have capacity to recruit, hire, manage, and train 
  6.6   mental health professionals, mental health practitioners, and 
  6.7   mental health rehabilitation workers; 
  6.8      (2) have adequate administrative ability to ensure 
  6.9   availability of services; 
  6.10     (3) ensure adequate preservice and inservice training for 
  6.11  staff; 
  6.12     (4) ensure that mental health professionals, mental health 
  6.13  practitioners, and mental health rehabilitation workers are 
  6.14  skilled in the delivery of the specific adult rehabilitative 
  6.15  mental health services provided to the individual eligible 
  6.16  recipient; 
  6.17     (5) ensure that staff is capable of implementing culturally 
  6.18  specific services that are culturally competent and appropriate 
  6.19  as determined by the recipient's culture, beliefs, values, and 
  6.20  language as identified in the individual treatment plan; 
  6.21     (6) ensure enough flexibility in service delivery to 
  6.22  respond to the changing and intermittent care needs of a 
  6.23  recipient as identified by the recipient and the individual 
  6.24  treatment plan; 
  6.25     (7) ensure that the mental health professional or mental 
  6.26  health practitioner, who is under the clinical supervision of a 
  6.27  mental health professional, involved in a recipient's services 
  6.28  participates in the development of the individual treatment 
  6.29  plan; 
  6.30     (8) assist the recipient in arranging needed crisis 
  6.31  assessment, intervention, and stabilization services; 
  6.32     (9) ensure that services are coordinated with other 
  6.33  recipient mental health services providers and the county mental 
  6.34  health authority and the federally recognized American Indian 
  6.35  authority and necessary others after obtaining the consent of 
  6.36  the recipient.  Services must also be coordinated with the 
  7.1   recipient's case manager or care coordinator, if the recipient 
  7.2   is receiving case management or care coordination services; 
  7.3      (10) develop and maintain recipient files, individual 
  7.4   treatment plans, and contact charting; 
  7.5      (11) develop and maintain staff training and personnel 
  7.6   files; 
  7.7      (12) submit information as required by the state; 
  7.8      (13) establish and maintain a quality assurance plan to 
  7.9   evaluate the outcome of services provided; 
  7.10     (14) keep all necessary records required by law; 
  7.11     (15) deliver services as required by section 245.461; 
  7.12     (16) comply with all applicable laws; 
  7.13     (17) be an enrolled Medicaid provider; 
  7.14     (18) maintain a quality assurance plan to determine 
  7.15  specific service outcomes and the recipient's satisfaction with 
  7.16  services; and 
  7.17     (19) develop and maintain written policies and procedures 
  7.18  regarding service provision and administration of the provider 
  7.19  entity. 
  7.20     Subd. 5.  [QUALIFICATIONS OF PROVIDER STAFF.] Adult 
  7.21  rehabilitative mental health services must be provided by 
  7.22  qualified individual provider staff of a certified provider 
  7.23  entity.  Individual provider staff must be qualified under one 
  7.24  of the following criteria: 
  7.25     (1) a mental health professional as defined in section 
  7.26  245.462, subdivision 18, clauses (1) to (5); 
  7.27     (2) a mental health practitioner as defined in section 
  7.28  245.462, subdivision 17.  The mental health practitioner must 
  7.29  work under the clinical supervision of a mental health 
  7.30  professional; or 
  7.31     (3) a mental health rehabilitation worker.  A mental health 
  7.32  rehabilitation worker means a staff person working under the 
  7.33  direction of a mental health practitioner or mental health 
  7.34  professional, and under the clinical supervision of a mental 
  7.35  health professional in the implementation of rehabilitative 
  7.36  mental health services as identified in the recipient's 
  8.1   individual treatment plan; and who: 
  8.2      (i) is at least 21 years of age; 
  8.3      (ii) has a high school diploma or equivalent; 
  8.4      (iii) has successfully completed 30 hours of training 
  8.5   during the past two years in all of the following areas:  
  8.6   recipient rights, recipient-centered individual treatment 
  8.7   planning, behavioral terminology, mental illness, co-occurring 
  8.8   mental illness and substance abuse, psychotropic medications and 
  8.9   side effects, functional assessment, local community resources, 
  8.10  adult vulnerability, recipient confidentiality; and 
  8.11     (iv) meets the qualifications in (A) or (B): 
  8.12     (A) has an associate of arts degree in one of the 
  8.13  behavioral sciences or human services, or is a registered nurse 
  8.14  without a bachelor's degree, or who within the previous ten 
  8.15  years has:  
  8.16     (1) three years of personal life experience with serious 
  8.17  and persistent mental illness; 
  8.18     (2) three years of life experience as a primary caregiver 
  8.19  to an adult with a serious mental illness or traumatic brain 
  8.20  injury; or 
  8.21     (3) 4,000 hours of supervised paid work experience in the 
  8.22  delivery of mental health services to adults with a serious 
  8.23  mental illness or traumatic brain injury; or 
  8.24     (B)(1) be fluent in the non-English language or competent 
  8.25  in the culture of the ethnic group to which at least 50 percent 
  8.26  of the mental health rehabilitation worker's clients belong; 
  8.27     (2) receives during the first 2,000 hours of work, monthly 
  8.28  documented individual clinical supervision by a mental health 
  8.29  professional; 
  8.30     (3) has 18 hours of documented field supervision by a 
  8.31  mental health professional or practitioner during the first 160 
  8.32  hours of contact work with recipients, and at least six hours of 
  8.33  field supervision quarterly during the following year; 
  8.34     (4) has review and cosignature of charting of recipient 
  8.35  contacts during field supervision by a mental health 
  8.36  professional or practitioner; and 
  9.1      (5) has 40 hours of additional continuing education on 
  9.2   mental health topics during the first year of employment. 
  9.3      Subd. 6.  [REQUIRED TRAINING AND SUPERVISION.] (a) Mental 
  9.4   health rehabilitation workers must receive ongoing continuing 
  9.5   education training of at least 30 hours every two years in areas 
  9.6   of mental illness and mental health services and other areas 
  9.7   specific to the population being served.  Mental health 
  9.8   rehabilitation workers must also be subject to the ongoing 
  9.9   direction and clinical supervision standards in paragraphs (c) 
  9.10  and (d). 
  9.11     (b) Mental health practitioners must receive ongoing 
  9.12  continuing education training as required by their professional 
  9.13  license; or if the practitioner is not licensed, the 
  9.14  practitioner must receive ongoing continuing education training 
  9.15  of at least 30 hours every two years in areas of mental illness 
  9.16  and mental health services.  Mental health practitioners must 
  9.17  meet the ongoing clinical supervision standards in paragraph (c).
  9.18     (c) A mental health professional providing clinical 
  9.19  supervision of staff delivering adult rehabilitative mental 
  9.20  health services must provide the following guidance: 
  9.21     (1) review the information in the recipient's file; 
  9.22     (2) review and approve initial and updates of individual 
  9.23  treatment plans; 
  9.24     (3) meet with mental health rehabilitation workers and 
  9.25  practitioners, individually or in small groups, at least monthly 
  9.26  to discuss treatment topics of interest to the workers and 
  9.27  practitioners; 
  9.28     (4) meet with mental health rehabilitation workers and 
  9.29  practitioners, individually or in small groups, at least monthly 
  9.30  to discuss treatment plans of recipients, and approve by 
  9.31  signature and document in the recipient's file any resulting 
  9.32  plan updates; 
  9.33     (5) meet at least twice a month with the directing mental 
  9.34  health practitioner, if there is one, to review needs of the 
  9.35  adult rehabilitative mental health services program, review 
  9.36  staff on-site observations and evaluate mental health 
 10.1   rehabilitation workers, plan staff training, review program 
 10.2   evaluation and development, and consult with the directing 
 10.3   practitioner; 
 10.4      (6) be available for urgent consultation as the individual 
 10.5   recipient needs or the situation necessitates; and 
 10.6      (7) provide clinical supervision by full- or part-time 
 10.7   mental health professionals employed by or under contract with 
 10.8   the provider entity. 
 10.9      (d) An adult rehabilitative mental health services provider 
 10.10  entity must have a treatment director who is a mental health 
 10.11  practitioner or mental professional.  The treatment director 
 10.12  must ensure the following: 
 10.13     (1) while delivering direct services to recipients, a newly 
 10.14  hired mental health rehabilitation worker must be directly 
 10.15  observed delivering services to recipients by the mental health 
 10.16  practitioner or mental health professional for at least six 
 10.17  hours per 40 hours worked during the first 160 hours that the 
 10.18  mental health rehabilitation worker works; 
 10.19     (2) the mental health rehabilitation worker must receive 
 10.20  ongoing on-site direct service observation by a mental health 
 10.21  professional or mental health practitioner for at least six 
 10.22  hours for every six months of employment; 
 10.23     (3) progress notes are reviewed from on-site service 
 10.24  observation prepared by the mental health rehabilitation worker 
 10.25  and mental health practitioner for accuracy and consistency with 
 10.26  actual recipient contact and the individual treatment plan and 
 10.27  goals; 
 10.28     (4) immediate availability by phone or in person for 
 10.29  consultation by a mental health professional or a mental health 
 10.30  practitioner to the mental health rehabilitation services worker 
 10.31  during service provision; 
 10.32     (5) oversee the identification of changes in individual 
 10.33  recipient treatment strategies, revise the plan and communicate 
 10.34  treatment instructions and methodologies as appropriate to 
 10.35  ensure that treatment is implemented correctly; 
 10.36     (6) model service practices which:  respect the recipient, 
 11.1   include the recipient in planning and implementation of the 
 11.2   individual treatment plan, recognize the recipient's strengths, 
 11.3   collaborate and coordinate with other involved parties and 
 11.4   providers; 
 11.5      (7) ensure that mental health practitioners and mental 
 11.6   health rehabilitation workers are able to effectively 
 11.7   communicate with the recipients, significant others, and 
 11.8   providers; and 
 11.9      (8) oversee the record of the results of on-site 
 11.10  observation and charting evaluation and corrective actions taken 
 11.11  to modify the work of the mental health practitioners and mental 
 11.12  health rehabilitation workers. 
 11.13     (e) A mental health practitioner who is providing treatment 
 11.14  direction for a provider entity must receive supervision at 
 11.15  least monthly from a mental health professional to: 
 11.16     (1) identify and plan for general needs of the recipient 
 11.17  population served; 
 11.18     (2) identify and plan to address provider entity program 
 11.19  needs and effectiveness; 
 11.20     (3) identify and plan provider entity staff training and 
 11.21  personnel needs and issues; and 
 11.22     (4) plan, implement, and evaluate provider entity quality 
 11.23  improvement programs.  
 11.24     Subd. 7.  [PERSONNEL FILE.] The adult rehabilitative mental 
 11.25  health services provider entity must maintain a personnel file 
 11.26  on each staff.  Each file must contain: 
 11.27     (1) an annual performance review; 
 11.28     (2) a summary of on-site service observations and charting 
 11.29  review; 
 11.30     (3) a criminal background check of all direct service 
 11.31  staff; 
 11.32     (4) evidence of academic degree and qualifications; 
 11.33     (5) a copy of professional license; 
 11.34     (6) any job performance recognition and disciplinary 
 11.35  actions; 
 11.36     (7) any individual staff written input into own personnel 
 12.1   file; 
 12.2      (8) all clinical supervision provided; and 
 12.3      (9) documentation of compliance with continuing education 
 12.4   requirements. 
 12.5      Subd. 8.  [DIAGNOSTIC ASSESSMENT.] Providers of adult 
 12.6   rehabilitative mental health services must complete a diagnostic 
 12.7   assessment as defined in section 245.462, subdivision 9, within 
 12.8   five days after the recipient's second visit or within 30 days 
 12.9   after intake, whichever occurs first.  In cases where a 
 12.10  diagnostic assessment is available that reflects the recipient's 
 12.11  current status, and has been completed within 180 days preceding 
 12.12  admission, an update must be completed.  An update shall include 
 12.13  a written summary by a mental health professional of the 
 12.14  recipient's current mental health status and service needs.  If 
 12.15  the recipient's mental health status has changed significantly 
 12.16  since the adult's most recent diagnostic assessment, a new 
 12.17  diagnostic assessment is required. 
 12.18     Subd. 9.  [FUNCTIONAL ASSESSMENT.] Providers of adult 
 12.19  rehabilitative mental health services must complete a written 
 12.20  functional assessment as defined in section 245.462, subdivision 
 12.21  11a, for each recipient.  The functional assessment must be 
 12.22  completed within 30 days of intake, and reviewed and updated at 
 12.23  least every six months after it is developed, unless there is a 
 12.24  significant change in the functioning of the recipient.  If 
 12.25  there is a significant change in functioning, the assessment 
 12.26  must be updated.  A single functional assessment can meet case 
 12.27  management and adult rehabilitative mental health services 
 12.28  requirements, if agreed to by the recipient.  Unless the 
 12.29  recipient refuses, the recipient must have significant 
 12.30  participation in the development of the functional assessment. 
 12.31     Subd. 10.  [INDIVIDUAL TREATMENT PLAN.] All providers of 
 12.32  adult rehabilitative mental health services must develop and 
 12.33  implement an individual treatment plan for each recipient.  The 
 12.34  provisions in clauses (1) and (2) apply: 
 12.35     (1) Individual treatment plan means a plan of intervention, 
 12.36  treatment, and services for an individual recipient written by a 
 13.1   mental health professional or by a mental health practitioner 
 13.2   under the clinical supervision of a mental health professional.  
 13.3   The individual treatment plan must be based on diagnostic and 
 13.4   functional assessments.  To the extent possible, the development 
 13.5   and implementation of a treatment plan must be a collaborative 
 13.6   process involving the recipient, and with the permission of the 
 13.7   recipient, the recipient's family and others in the recipient's 
 13.8   support system.  Providers of adult rehabilitative mental health 
 13.9   services must develop the individual treatment plan within 30 
 13.10  calendar days of intake.  The treatment plan must be updated at 
 13.11  least every six months thereafter, or more often when there is 
 13.12  significant change in the recipient's situation or functioning, 
 13.13  or in services or service methods to be used, or at the request 
 13.14  of the recipient or the recipient's legal guardian. 
 13.15     (2) The individual treatment plan must include: 
 13.16     (i) a list of problems identified in the assessment; 
 13.17     (ii) the recipient's strengths and resources; 
 13.18     (iii) concrete, measurable goals to be achieved, including 
 13.19  time frames for achievement; 
 13.20     (iv) specific objectives directed toward the achievement of 
 13.21  each one of the goals; 
 13.22     (v) documentation of participants in the treatment planning.
 13.23  The recipient, if possible, must be a participant.  The 
 13.24  recipient or the recipient's legal guardian must sign the 
 13.25  treatment plan, or documentation must be provided why this was 
 13.26  not possible.  A copy of the plan must be given to the recipient 
 13.27  or legal guardian.  Referral to formal services should be 
 13.28  arranged, including specific providers where applicable; 
 13.29     (vi) cultural considerations, resources, and needs of the 
 13.30  recipient should be included; 
 13.31     (vii) planned frequency and type of services should be 
 13.32  initiated; and 
 13.33     (viii) clear progress notes on outcome of goals. 
 13.34     (3) The individual community support plan defined in 
 13.35  section 245.462, subdivision 12, may serve as the individual 
 13.36  treatment plan if there is involvement of a mental health case 
 14.1   manager, and with the approval of the recipient.  The individual 
 14.2   community support plan must include the criteria in clause (2). 
 14.3      Subd. 11.  [RECIPIENT FILE.] Providers of adult 
 14.4   rehabilitative mental health services must maintain a file for 
 14.5   each recipient that contains the following information: 
 14.6      (1) diagnostic assessment or verification of its location, 
 14.7   that is current and that was reviewed by a mental health 
 14.8   professional who is employed by or under contract with the 
 14.9   provider entity; 
 14.10     (2) functional assessments; 
 14.11     (3) individual treatment plans signed by the recipient and 
 14.12  the mental health professional, or if the recipient refused to 
 14.13  sign the plan, the date and reason stated by the recipient as to 
 14.14  why the recipient would not sign the plan; 
 14.15     (4) recipient history; 
 14.16     (5) signed release forms; 
 14.17     (6) recipient health information and current medications; 
 14.18     (7) emergency contacts for the recipient; 
 14.19     (8) case records which document the date of service, the 
 14.20  place of service delivery, signature of the person providing the 
 14.21  service, nature, extent and units of service, and place of 
 14.22  service delivery; 
 14.23     (9) contacts, direct or by telephone, with recipient's 
 14.24  family or others, other providers, or other resources for 
 14.25  service coordination; 
 14.26     (10) summary of recipient case reviews by staff; and 
 14.27     (11) written information by the recipient that the 
 14.28  recipient requests be included in the file. 
 14.29     Subd. 12.  [ADDITIONAL REQUIREMENTS.] (a) Providers of 
 14.30  adult rehabilitative mental health services must comply with 
 14.31  section 245.467, subdivision 4. 
 14.32     (b) Adult rehabilitative mental health services are 
 14.33  provided for most recipients in the recipient's home and 
 14.34  community.  Services may also be provided at the home of a 
 14.35  relative or significant other, job site, psychosocial clubhouse, 
 14.36  drop-in center, social setting, classroom, or other places in 
 15.1   the community.  Except for "transition to community services," 
 15.2   the place of service does not include a regional treatment 
 15.3   center, nursing home, Rule 36 residential treatment facility, 
 15.4   board and lodging, or an acute care hospital. 
 15.5      (c) Adult rehabilitative mental health services may be 
 15.6   provided in group settings if appropriate to each participating 
 15.7   recipient's needs and treatment plan.  A group is defined as two 
 15.8   to ten clients, at least one of whom is a recipient, who is 
 15.9   concurrently receiving a service which is identified in this 
 15.10  section.  The service and group must be specified in the 
 15.11  recipient's treatment plan.  No more than two qualified staff 
 15.12  may bill Medicaid for services provided to the same group of 
 15.13  recipients.  If two adult rehabilitative mental health workers 
 15.14  bill for recipients in the same group session, they must each 
 15.15  bill for different recipients. 
 15.16     Subd. 13.  [TRAVEL TIME.] Adult rehabilitative mental 
 15.17  health services provider travel time to and from the recipient 
 15.18  contact site is a billable adult rehabilitative mental health 
 15.19  service. 
 15.20     Subd. 14.  [EXCLUDED SERVICES.] The following services are 
 15.21  excluded from reimbursement as adult rehabilitative mental 
 15.22  health services: 
 15.23     (1) recipient transportation services; 
 15.24     (2) a service provided and billed by a provider who is not 
 15.25  enrolled to provide adult rehabilitative mental health service; 
 15.26     (3) adult rehabilitative mental health services performed 
 15.27  by volunteers; 
 15.28     (4) provider performance of household tasks, chores, or 
 15.29  related activities, such as laundering clothes, moving the 
 15.30  recipient's household, housekeeping, and grocery shopping for 
 15.31  the recipient; 
 15.32     (5) direct billing of time spent "on call" when not 
 15.33  delivering services to recipients; 
 15.34     (6) activities which are primarily social or recreational 
 15.35  in nature, rather than rehabilitative, for the individual 
 15.36  recipient, as determined by the individual's needs and treatment 
 16.1   plan; 
 16.2      (7) job-specific skills services, such as on-the-job 
 16.3   training; 
 16.4      (8) provider service time included in case management 
 16.5   reimbursement; 
 16.6      (9) outreach services to potential recipients; and 
 16.7      (10) a mental health service that is not medically 
 16.8   necessary. 
 16.9      Subd. 15.  [SERVICE LIMITS PRIOR TO 
 16.10  AUTHORIZATION.] Reimbursable adult rehabilitative mental health 
 16.11  services are limited to the following amounts unless authorized 
 16.12  for an individual recipient by the commissioner: 
 16.13     (1) individual and group adult rehabilitative mental health 
 16.14  services, excluding day treatment services, are limited to 260 
 16.15  hours per six months; 
 16.16     (2) day treatment services are limited to 60 hours per six 
 16.17  months; and 
 16.18     (3) up to six months of coordinated services from both the 
 16.19  children and adult mental health rehabilitation services systems 
 16.20  can be provided to a young adult recipient transitioning from 
 16.21  children mental health services to adult mental health services, 
 16.22  as defined in section 245.4875, subdivision 8, not to exceed 260 
 16.23  hours combined for children and adult mental health 
 16.24  rehabilitation services. 
 16.25     Subd. 16.  [BILLING WHEN SERVICES ARE PROVIDED BY QUALIFIED 
 16.26  STATE STAFF.] When rehabilitative services are provided by 
 16.27  qualified state staff who are assigned to pilot projects under 
 16.28  section 245.4661, the county or other local entity to which the 
 16.29  qualified state staff are assigned may consider these staff part 
 16.30  of the local provider entity for which certification is sought 
 16.31  under this section, and may bill the medical assistance program 
 16.32  for qualifying services provided by the qualified state staff.  
 16.33  Notwithstanding section 256.025, subdivision 2, payments for 
 16.34  services provided by state staff who are assigned to adult 
 16.35  mental health initiatives shall only be made from federal funds. 
 16.36     Sec. 6.  [256B.0624] [ADULT MENTAL HEALTH CRISIS RESPONSE 
 17.1   SERVICES.] 
 17.2      Subdivision 1.  [SCOPE.] Medical assistance covers adult 
 17.3   mental health crisis response services as defined in subdivision 
 17.4   2, paragraphs (c) to (e), subject to federal approval, if 
 17.5   provided to a recipient as defined in subdivision 3 and provided 
 17.6   by a qualified provider entity as defined in this section and by 
 17.7   a qualified individual provider working within the provider's 
 17.8   scope of practice and as defined in this subdivision and 
 17.9   identified in the recipient's individual crisis treatment plan 
 17.10  as defined in subdivisions 10 and 13 and if determined to be 
 17.11  medically necessary.  
 17.12     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
 17.13  following terms have the meanings given them. 
 17.14     (a) "Mental health crisis" is an adult behavioral, 
 17.15  emotional, or psychiatric situation which, but for the provision 
 17.16  of crisis response services, would likely result in 
 17.17  significantly reduced levels of functioning in primary 
 17.18  activities of daily living, or in an emergency situation, or in 
 17.19  the placement of the recipient in a more restrictive setting, 
 17.20  including, but not limited to, inpatient hospitalization.  
 17.21     (b) "Mental health emergency" is an adult behavioral, 
 17.22  emotional, or psychiatric situation which poses an immediate 
 17.23  threat to the physical health or safety of the recipient or 
 17.24  others.  
 17.25     A mental health crisis or emergency is determined for 
 17.26  medical assistance service reimbursement by a physician, a 
 17.27  mental health professional, or crisis mental health practitioner 
 17.28  with input from the recipient whenever possible. 
 17.29     (c) "Mental health crisis assessment" means an immediate 
 17.30  face-to-face assessment by a physician, a mental health 
 17.31  professional, or mental health practitioner under the clinical 
 17.32  supervision of a mental health professional, following a 
 17.33  screening that suggests that the adult may be experiencing a 
 17.34  mental health crisis or mental health emergency situation. 
 17.35     (d) "Mental health mobile crisis intervention services" 
 17.36  means face-to-face, short-term intensive mental health services 
 18.1   initiated during a mental health crisis or mental health 
 18.2   emergency to help the recipient cope with immediate stressors, 
 18.3   identify and utilize available resources and strengths, and 
 18.4   begin to return to the recipient's baseline level of functioning.
 18.5      (1) This service is provided on-site by a mobile crisis 
 18.6   intervention team outside of an inpatient hospital setting.  
 18.7   Mental health mobile crisis intervention services must be 
 18.8   available 24 hours a day, seven days a week.  
 18.9      (2) The initial screening should consider other available 
 18.10  services to determine which service intervention would best 
 18.11  address the recipient's needs and circumstances.  
 18.12     (3) The mobile crisis intervention team should be available 
 18.13  to meet promptly face-to-face with a person in mental health 
 18.14  crisis or emergency in a community setting.  
 18.15     (4) The intervention must consist of an assessment and a 
 18.16  crisis treatment plan.  
 18.17     (5) The treatment plan must include recommendations for any 
 18.18  needed crisis stabilization services for the recipient. 
 18.19     (e) "Mental health crisis stabilization services" means 
 18.20  individualized services provided in a community setting in the 
 18.21  recipient's home, home of a family or friend of the recipient, 
 18.22  or other community setting or short-term residential setting 
 18.23  designed to restore a recipient to the recipient's prior 
 18.24  functional level.  Mental health crisis stabilization does not 
 18.25  include partial hospitalization or day treatment. 
 18.26     Subd. 3.  [ELIGIBILITY.] An eligible recipient is an 
 18.27  individual who: 
 18.28     (1) is age 18 or older; 
 18.29     (2) is screened as possibly experiencing a mental health 
 18.30  crisis or emergency where a mental health crisis assessment is 
 18.31  needed; and 
 18.32     (3) is assessed as experiencing a mental health crisis or 
 18.33  emergency, and mental health crisis intervention or crisis 
 18.34  intervention and stabilization services are determined to be 
 18.35  medically necessary and appropriate considering the safety 
 18.36  factor of the recipient and provider. 
 19.1      Subd. 4.  [PROVIDER ENTITY STANDARDS.] (a) A provider 
 19.2   entity is an entity that meets the standards listed in paragraph 
 19.3   (b) and: 
 19.4      (1) is a county board operated entity; or 
 19.5      (2) is a provider entity that is under contract with the 
 19.6   county board in the county where the potential crisis or 
 19.7   emergency is occurring.  To provide services under this section, 
 19.8   the provider entity must directly provide the services; or if 
 19.9   services are subcontracted, the provider entity must maintain 
 19.10  responsibility for services and billing. 
 19.11     (b) The adult mental health crisis response services 
 19.12  provider entity must meet the following standards: 
 19.13     (1) has the capacity to recruit, hire, and manage and train 
 19.14  mental health professionals, practitioners, and rehabilitation 
 19.15  workers; 
 19.16     (2) has adequate administrative ability to ensure 
 19.17  availability of services; 
 19.18     (3) is able to ensure adequate preservice and in-service 
 19.19  training; 
 19.20     (4) is able to ensure that staff providing these services 
 19.21  are skilled in the delivery of mental health crisis response 
 19.22  services to recipients; 
 19.23     (5) is able to ensure that staff are capable of 
 19.24  implementing culturally specific treatment identified in the 
 19.25  individual treatment plan that is meaningful and appropriate as 
 19.26  determined by the recipient's culture, beliefs, values, and 
 19.27  language; 
 19.28     (6) is able to ensure enough flexibility to respond to the 
 19.29  changing intervention and care needs of a recipient as 
 19.30  identified by the recipient during the service partnership 
 19.31  between the recipient and providers; 
 19.32     (7) is able to ensure that mental health professionals and 
 19.33  mental health practitioners have the communication tools and 
 19.34  procedures to communicate and consult promptly about crisis 
 19.35  assessment and interventions as services occur; 
 19.36     (8) is able to coordinate these services with county 
 20.1   emergency services and mental health crisis services; 
 20.2      (9) is able to ensure that mental health crisis assessment 
 20.3   and mobile crisis intervention services are available 24 hours a 
 20.4   day, seven days a week; 
 20.5      (10) is able to ensure that services are coordinated with 
 20.6   other mental health service providers, county mental health 
 20.7   authorities, or federally recognized American Indian authorities 
 20.8   and others as necessary, with the consent of the adult.  
 20.9   Services must also be coordinated with the recipient's case 
 20.10  manager if the adult is receiving case management services; 
 20.11     (11) is able to ensure that crisis intervention services 
 20.12  are provided in a manner consistent with sections 245.461 to 
 20.13  245.486; 
 20.14     (12) is able to submit information as required by the 
 20.15  state; 
 20.16     (13) maintains staff training and personnel files; 
 20.17     (14) is able to establish and maintain a quality assurance 
 20.18  and evaluation plan to evaluate the outcomes of services and 
 20.19  recipient satisfaction; 
 20.20     (15) is able to keep records as required by applicable 
 20.21  laws; 
 20.22     (16) is able to comply with all applicable laws and 
 20.23  statutes; 
 20.24     (17) is an enrolled medical assistance provider; and 
 20.25     (18) develops and maintains written policies and procedures 
 20.26  regarding service provision and administration of the provider 
 20.27  entity.  
 20.28     Subd. 5.  [MOBILE CRISIS INTERVENTION STAFF 
 20.29  QUALIFICATIONS.] For provision of adult mental health mobile 
 20.30  crisis intervention services, a mobile crisis intervention team 
 20.31  is comprised of at least two mental health professionals as 
 20.32  defined in section 245.462, subdivision 18, clauses (1) to (5), 
 20.33  or a combination of at least one mental health professional and 
 20.34  one mental health practitioner as defined in section 245.462, 
 20.35  subdivision 17, with the required mental health crisis training 
 20.36  and under the clinical supervision of a mental health 
 21.1   professional on the team.  The team must have at least two 
 21.2   people with at least one member providing on-site crisis 
 21.3   intervention services when needed.  Team members must be 
 21.4   experienced in mental health assessment, crisis intervention 
 21.5   techniques, and clinical decision-making under emergency 
 21.6   conditions and have knowledge of local services and resources.  
 21.7   The team must recommend and coordinate the team's services with 
 21.8   appropriate local resources such as the county social services 
 21.9   agency, corrections department, and mental health services when 
 21.10  necessary. 
 21.11     Subd. 6.  [ADULT NONRESIDENTIAL CRISIS STABILIZATION STAFF 
 21.12  QUALIFICATIONS.] Adult nonresidential mental health crisis 
 21.13  stabilization services must be provided by qualified individual 
 21.14  staff of a qualified provider entity.  Individual provider staff 
 21.15  must have the following qualifications: 
 21.16     (1) be a mental health professional as defined in section 
 21.17  245.462, subdivision 18, clauses (1) to (5); 
 21.18     (2) be a mental health practitioner as defined in section 
 21.19  245.462, subdivision 17.  The mental health practitioner must 
 21.20  work under the clinical supervision of a mental health 
 21.21  professional with the required mental health crisis training; or 
 21.22     (3) be a mental health rehabilitation worker who is a staff 
 21.23  member working under the direction of a mental health 
 21.24  practitioner or a mental health professional, and is under the 
 21.25  clinical supervision of a mental health professional while 
 21.26  providing the mental health crisis stabilization services as 
 21.27  identified in the recipient's individual crisis stabilization 
 21.28  plan and who meets the qualifications in section 256B.0623. 
 21.29     Subd. 7.  [ADULT RESIDENTIAL CRISIS STABILIZATION STAFF 
 21.30  QUALIFICATIONS.] Adult residential mental health crisis 
 21.31  stabilization services must be provided by qualified individual 
 21.32  staff of a qualified provider entity.  Crisis stabilization 
 21.33  services must be available in the residential setting 24 hours a 
 21.34  day, seven days a week.  Individual provider staff must be one 
 21.35  of the following: 
 21.36     (1) a mental health professional as defined in section 
 22.1   245.462, subdivision 18, clauses (1) to (5); 
 22.2      (2) a mental health practitioner as defined in section 
 22.3   245.462, subdivision 17.  The mental health practitioner must 
 22.4   have the required mental health crisis training and work under 
 22.5   the clinical supervision of a mental health professional; or 
 22.6      (3) a mental health rehabilitation worker who is a staff 
 22.7   member working under the direction of a mental health 
 22.8   practitioner or a mental health professional, is under the 
 22.9   clinical supervision of a mental health professional while 
 22.10  providing mental health crisis stabilization services as 
 22.11  identified in the recipient's individual crisis stabilization 
 22.12  plan and meets the qualifications in section 256B.0623, and has 
 22.13  the required mental health crisis training. 
 22.14     Subd. 8.  [SUPERVISION.] Mental health practitioners may 
 22.15  provide crisis assessment and mobile crisis intervention 
 22.16  services if the following clinical supervision requirements are 
 22.17  met: 
 22.18     (1) the mental health provider entity must accept full 
 22.19  responsibility for the services provided; 
 22.20     (2) the mental health professional of the provider entity, 
 22.21  who is an employee or under contract with the provider entity, 
 22.22  must be available by phone or in person for clinical 
 22.23  supervision; 
 22.24     (3) the mental health professional is consulted, in person 
 22.25  or by phone, during the first three hours when a mental health 
 22.26  practitioner provides on-site service; 
 22.27     (4) the mental health professional must: 
 22.28     (i) review and approve of the tentative crisis assessment 
 22.29  and crisis treatment plan; 
 22.30     (ii) document the consultation; and 
 22.31     (iii) sign the crisis assessment and treatment plan within 
 22.32  the next business day; 
 22.33     (5) if the mobile crisis intervention services continue 
 22.34  into a second day, a mental health professional must contact the 
 22.35  recipient face-to-face on the second day to provide services and 
 22.36  update the crisis treatment plan; and 
 23.1      (6) the on-site observation must be documented in the 
 23.2   recipient's record and signed by the mental health professional. 
 23.3      Subd. 9.  [INITIAL SCREENING.] Prior to initiating on-site 
 23.4   intervention by the mobile crisis intervention team, an initial 
 23.5   screening of the potential crisis situation must be made using 
 23.6   the resources of the crisis assistance or emergency services as 
 23.7   defined in sections 245.462, subdivision 6, and 245.469, 
 23.8   subdivisions 1 and 2.  The following components must be 
 23.9   performed as part of the mental health crisis intervention 
 23.10  services following a crisis assessment: 
 23.11     (1) provide prompt on-site intervention, as appropriate to 
 23.12  the situation and safety of the provider, to relieve distress 
 23.13  and to reduce safety risks to the recipient and others; 
 23.14     (2) the mental health practitioner must consult with the 
 23.15  mental health professional, as opportunity presents, during the 
 23.16  intervention to review the assessment, intervention plan, and 
 23.17  actions taken; 
 23.18     (3) conduct a culturally appropriate assessment which 
 23.19  evaluates the recipient's current life situation and sources of 
 23.20  stress, the recipient's current mental health problems, 
 23.21  strengths, and vulnerabilities, and the recipient's current 
 23.22  functioning and symptoms; 
 23.23     (4) develop a written short-term crisis treatment plan 
 23.24  within 24 hours of the initial intervention to describe 
 23.25  concrete, measurable goals, including the necessary time frames 
 23.26  for the frequency of services and achieving the goals to reduce 
 23.27  or eliminate the crisis.  The team must involve the recipient 
 23.28  and, with the permission of the recipient, persons in the 
 23.29  recipient's support system and other relevant providers in 
 23.30  developing and implementing the plan; and 
 23.31     (5) with the implementation of crisis treatment plan, when 
 23.32  the recipient shows positive change to a baseline level of 
 23.33  functioning or decrease in personal distress, the team must 
 23.34  document that the short-term goals have been met, and that no 
 23.35  further crisis response services are required; or if the 
 23.36  recipient is stabilized but requires a referral to less 
 24.1   intensive services or crisis stabilization services, the team 
 24.2   must implement access to these services.  If the recipient has a 
 24.3   case manager, planning should be coordinated with the case 
 24.4   manager. 
 24.5      Subd. 10.  [RECIPIENT FILE.] Providers of mobile crisis 
 24.6   intervention or crisis stabilization services must maintain a 
 24.7   file for each recipient containing the following information: 
 24.8      (1) individual crisis treatment plans signed by the 
 24.9   recipient, mental health professional, and mental health 
 24.10  practitioner who developed the crisis treatment plan, or if the 
 24.11  recipient refused to sign the plan, the date and reason stated 
 24.12  by the recipient as to why the recipient would not sign the 
 24.13  plan; 
 24.14     (2) signed release forms; 
 24.15     (3) recipient health information and current medications; 
 24.16     (4) emergency contacts for the recipient; 
 24.17     (5) case records which document the date of service, place 
 24.18  of service delivery, signature of the person providing the 
 24.19  service, and the nature, extent, and units of service.  Direct 
 24.20  or telephone contact with the recipient's family or others 
 24.21  should be documented; 
 24.22     (6) required clinical supervision by mental health 
 24.23  professionals; 
 24.24     (7) summary of the recipient's case reviews by staff; and 
 24.25     (8) any written information by the recipient that the 
 24.26  recipient wants in the file. 
 24.27  Documentation in the file must comply with all requirements of 
 24.28  the commissioner. 
 24.29     Subd. 11.  [CRISIS STABILIZATION SERVICES.] (a) Following a 
 24.30  mental health crisis or emergency, a recipient may need crisis 
 24.31  stabilization services to restore and support the recipient to a 
 24.32  functional level sufficient to allow the recipient to cope in 
 24.33  the recipient's usual living arrangement. 
 24.34     (b) Crisis stabilization services provided in the 
 24.35  recipient's home or in a community, nonresidential setting must 
 24.36  meet the following standards: 
 25.1      (1) a crisis stabilization treatment plan developed with 
 25.2   the recipient the day services begin, or before, by a provider 
 25.3   who is a mental health practitioner or professional; 
 25.4      (2) a mental health professional who is a crisis 
 25.5   stabilization services provider evaluates the recipient's 
 25.6   situation and approves the crisis stabilization treatment plan; 
 25.7      (3) provider staff must be qualified as a mental health 
 25.8   rehabilitation worker with the required mental health crisis 
 25.9   training working under the direction of a mental health 
 25.10  practitioner and under the clinical supervision of a mental 
 25.11  health professional; or as a mental health practitioner with the 
 25.12  required mental health crisis training working under the 
 25.13  clinical supervision of a mental health professional; or as a 
 25.14  mental health professional; and 
 25.15     (4) services must include face-to-face contact by the 
 25.16  crisis services mental health practitioner or mental health 
 25.17  rehabilitation worker with the recipient for further assessment, 
 25.18  help with referrals, updating of the crisis stabilization 
 25.19  treatment plan, supportive counseling, skills training, and 
 25.20  collaboration with other service providers in the community. 
 25.21     (c) The crisis stabilization services may be provided in a 
 25.22  supervised residential setting.  Providers of crisis 
 25.23  stabilization services in a residential setting must be 
 25.24  appropriately licensed and meet the following criteria: 
 25.25     (1) if the residential program serves no more than four 
 25.26  adults, and no more than two are recipients of residential 
 25.27  crisis stabilization services, services must meet the following 
 25.28  standards: 
 25.29     (i) services are provided by a mental health professional 
 25.30  who is a crisis stabilization services provider who evaluates 
 25.31  the recipient's situation and approves the crisis stabilization 
 25.32  treatment plan prior to placement; 
 25.33     (ii) the crisis stabilization treatment plan must be 
 25.34  developed with the recipient prior to placement; 
 25.35     (iii) at least one residential staff member working with 
 25.36  the recipient must be qualified as a mental health 
 26.1   rehabilitation worker and have completed 30 hours of training in 
 26.2   crisis intervention and stabilization; 
 26.3      (iv) have 24-hour-a-day staffing; 
 26.4      (v) have daily face-to-face contact by the crisis services 
 26.5   mental health practitioner or mental health professional with 
 26.6   the recipient for further assessment, help with referrals, 
 26.7   updating of crisis stabilization treatment plans, consultation 
 26.8   with residential staff, and collaboration with other service 
 26.9   providers in the community; and 
 26.10     (vi) have 24-hour-a-day residential staff access to a 
 26.11  crisis services mental health practitioner or mental health 
 26.12  professional; and 
 26.13     (2) if the residential program serves more than four 
 26.14  adults, and one or more are recipients of residential crisis 
 26.15  stabilization services, services must include: 
 26.16     (i) evaluation of the recipient's situation and approval of 
 26.17  the crisis stabilization treatment plan by a mental health 
 26.18  professional prior to placement; 
 26.19     (ii) crisis stabilization treatment planning developed with 
 26.20  the recipient prior to placement; 
 26.21     (iii) at least one residential staff member on duty 24 
 26.22  hours per day must be qualified as a mental health 
 26.23  rehabilitation worker and have completed 30 hours of training in 
 26.24  crisis intervention and stabilization; 
 26.25     (iv) have daily face-to-face contact by the crisis 
 26.26  stabilization services mental health practitioner or mental 
 26.27  health professional with the recipient for further assessment, 
 26.28  help with referrals, updating of crisis stabilization treatment 
 26.29  plans, consultation with residential staff, supportive 
 26.30  counseling, skills training, and collaboration with other 
 26.31  service providers in the community; 
 26.32     (v) have at least two residential staff members working 24 
 26.33  hours a day for the first 48 hours that the recipient is in the 
 26.34  residential program, and adjust staffing levels according to the 
 26.35  crisis stabilization treatment plan thereafter; and 
 26.36     (vi) have 24-hour-a-day residential staff access to a 
 27.1   crisis services mental health practitioner or mental health 
 27.2   professional.  
 27.3      Subd. 12.  [TREATMENT PLAN.] The individual crisis 
 27.4   stabilization treatment plan must include, at a minimum: 
 27.5      (1) a list of problems identified in the assessment; 
 27.6      (2) a list of the recipient's strengths and resources; 
 27.7      (3) concrete, measurable short-term goals and tasks to be 
 27.8   achieved, including time frames for achievement; 
 27.9      (4) specific objectives directed toward the achievement of 
 27.10  each one of the goals; 
 27.11     (5) documentation of the participants involved in the 
 27.12  service planning.  The recipient, if possible, must be a 
 27.13  participant.  The recipient or the recipient's legal guardian 
 27.14  must sign the service plan or documentation must be provided why 
 27.15  this was not possible.  A copy of the plan must be given to the 
 27.16  recipient and the recipient's legal guardian.  The plan should 
 27.17  include services arranged, including specific providers where 
 27.18  applicable; 
 27.19     (6) planned frequency and type of services initiated; 
 27.20     (7) a crisis response action plan if a crisis should occur; 
 27.21     (8) clear progress notes on outcome of goals; 
 27.22     (9) a written plan must be completed within 24 hours of 
 27.23  beginning services with the recipient; and 
 27.24     (10) a plan must be developed with and signed by the mental 
 27.25  health practitioner under the supervision of a mental health 
 27.26  professional.  
 27.27     Subd. 13.  [TRAVEL TIME.] An adult mental health crisis 
 27.28  response services provider travel time to and from the recipient 
 27.29  contact site is a direct billable mental health crisis response 
 27.30  service.  
 27.31     Subd. 14.  [EXCLUDED SERVICES.] The following services are 
 27.32  excluded from reimbursement under this section: 
 27.33     (1) room and board services; 
 27.34     (2) services delivered to a recipient while admitted to an 
 27.35  inpatient hospital; 
 27.36     (3) recipient transportation costs may be covered under 
 28.1   other medical assistance provisions, but transportation services 
 28.2   are not an adult mental health crisis response service; 
 28.3      (4) services provided and billed by a provider who is not 
 28.4   enrolled under medical assistance to provide adult mental health 
 28.5   crisis response services; 
 28.6      (5) services performed by volunteers; 
 28.7      (6) direct billing of time spent "on call" when not 
 28.8   delivering services to a recipient; 
 28.9      (7) provider service time included in case management 
 28.10  reimbursement.  When a provider is eligible to provide more than 
 28.11  one type of medical assistance service, the recipient must have 
 28.12  a choice of provider for each service, unless otherwise provided 
 28.13  for by law; 
 28.14     (8) outreach services to potential recipients; and 
 28.15     (9) a mental health service that is not medically necessary.
 28.16     Subd. 15.  [SERVICE LIMITS PRIOR TO 
 28.17  AUTHORIZATION.] Reimbursable adult mental health crisis response 
 28.18  services are limited to the following number of services unless 
 28.19  the commissioner authorizes more for an individual recipient: 
 28.20     (1) for mental health crisis assessment services, up to two 
 28.21  assessments within a week with a maximum of eight assessments 
 28.22  within a year; 
 28.23     (2) for mental health mobile crisis intervention services, 
 28.24  up to six consecutive intervention days per crisis episode; with 
 28.25  a maximum of four episodes per 12-month period.  To allow close 
 28.26  coordination and assessment of transition services, one day of 
 28.27  mobile crisis intervention billing may be permitted per episode 
 28.28  while the recipient is in the first day of the crisis 
 28.29  residential stabilization program; 
 28.30     (3) for residential mental health crisis stabilization 
 28.31  services, up to seven consecutive intervention days per crisis 
 28.32  episode; up to four episodes per 12-month period; and 
 28.33     (4) for nonresidential mental health crisis stabilization 
 28.34  services, up to 150 hours of services within 60 days per crisis 
 28.35  episode.  Services must follow a mental health crisis 
 28.36  intervention episode.  These billable service hours are outside 
 29.1   any adult rehabilitative mental health services limitations. 
 29.2      Sec. 7.  Minnesota Statutes 2000, section 256B.0625, 
 29.3   subdivision 20, is amended to read: 
 29.4      Subd. 20.  [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 
 29.5   extent authorized by rule of the state agency, medical 
 29.6   assistance covers case management services to persons with 
 29.7   serious and persistent mental illness and children with severe 
 29.8   emotional disturbance.  Services provided under this section 
 29.9   must meet the relevant standards in sections 245.461 to 
 29.10  245.4888, the Comprehensive Adult and Children's Mental Health 
 29.11  Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 
 29.12  9505.0322, excluding subpart 10. 
 29.13     (b) Entities meeting program standards set out in rules 
 29.14  governing family community support services as defined in 
 29.15  section 245.4871, subdivision 17, are eligible for medical 
 29.16  assistance reimbursement for case management services for 
 29.17  children with severe emotional disturbance when these services 
 29.18  meet the program standards in Minnesota Rules, parts 9520.0900 
 29.19  to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 
 29.20     (c) Medical assistance and MinnesotaCare payment for mental 
 29.21  health case management shall be made on a monthly basis.  In 
 29.22  order to receive payment for an eligible child, the provider 
 29.23  must document at least a face-to-face contact with the child, 
 29.24  the child's parents, or the child's legal representative.  To 
 29.25  receive payment for an eligible adult, the provider must 
 29.26  document: 
 29.27     (1) at least a face-to-face contact with the adult or the 
 29.28  adult's legal representative; or 
 29.29     (2) at least a telephone contact with the adult or the 
 29.30  adult's legal representative and document a face-to-face contact 
 29.31  with the adult or the adult's legal representative within the 
 29.32  preceding two months. 
 29.33     (d) Payment for mental health case management provided by 
 29.34  county or state staff shall be based on the monthly rate 
 29.35  methodology under section 256B.094, subdivision 6, paragraph 
 29.36  (b), with separate rates calculated for child welfare and mental 
 30.1   health, and within mental health, separate rates for children 
 30.2   and adults. 
 30.3      (e) Payment for mental health case management provided by 
 30.4   Indian health services or by agencies operated by Indian tribes 
 30.5   may be made according to this section or other relevant 
 30.6   federally approved rate setting methodology. 
 30.7      (f) Payment for mental health case management provided by 
 30.8   county-contracted vendors who contract with a county or Indian 
 30.9   tribe shall be based on a monthly rate negotiated by the host 
 30.10  county or tribe.  The negotiated rate must not exceed the rate 
 30.11  charged by the vendor for the same service to other payers.  If 
 30.12  the service is provided by a team of contracted vendors, the 
 30.13  county or tribe may negotiate a team rate with a vendor who is a 
 30.14  member of the team.  The team shall determine how to distribute 
 30.15  the rate among its members.  No reimbursement received by 
 30.16  contracted vendors shall be returned to the county or tribe, 
 30.17  except to reimburse the county or tribe for advance funding 
 30.18  provided by the county or tribe to the vendor. 
 30.19     (f) (g) If the service is provided by a team which includes 
 30.20  contracted vendors, tribal staff, and county or state staff, the 
 30.21  costs for county or state staff participation in the team shall 
 30.22  be included in the rate for county-provided services.  In this 
 30.23  case, the contracted vendor, the tribal agency, and the county 
 30.24  may each receive separate payment for services provided by each 
 30.25  entity in the same month.  In order to prevent duplication of 
 30.26  services, the county each entity must document, in the 
 30.27  recipient's file, the need for team case management and a 
 30.28  description of the roles of the team members. 
 30.29     (g) (h) The commissioner shall calculate the nonfederal 
 30.30  share of actual medical assistance and general assistance 
 30.31  medical care payments for each county, based on the higher of 
 30.32  calendar year 1995 or 1996, by service date, project that amount 
 30.33  forward to 1999, and transfer one-half of the result from 
 30.34  medical assistance and general assistance medical care to each 
 30.35  county's mental health grants under sections 245.4886 and 
 30.36  256E.12 for calendar year 1999.  The annualized minimum amount 
 31.1   added to each county's mental health grant shall be $3,000 per 
 31.2   year for children and $5,000 per year for adults.  The 
 31.3   commissioner may reduce the statewide growth factor in order to 
 31.4   fund these minimums.  The annualized total amount transferred 
 31.5   shall become part of the base for future mental health grants 
 31.6   for each county. 
 31.7      (h) (i) Any net increase in revenue to the county or tribe 
 31.8   as a result of the change in this section must be used to 
 31.9   provide expanded mental health services as defined in sections 
 31.10  245.461 to 245.4888, the Comprehensive Adult and Children's 
 31.11  Mental Health Acts, excluding inpatient and residential 
 31.12  treatment.  For adults, increased revenue may also be used for 
 31.13  services and consumer supports which are part of adult mental 
 31.14  health projects approved under Laws 1997, chapter 203, article 
 31.15  7, section 25.  For children, increased revenue may also be used 
 31.16  for respite care and nonresidential individualized 
 31.17  rehabilitation services as defined in section 245.492, 
 31.18  subdivisions 17 and 23.  "Increased revenue" has the meaning 
 31.19  given in Minnesota Rules, part 9520.0903, subpart 3.  
 31.20     (i) (j) Notwithstanding section 256B.19, subdivision 1, the 
 31.21  nonfederal share of costs for mental health case management 
 31.22  shall be provided by the recipient's county of responsibility, 
 31.23  as defined in sections 256G.01 to 256G.12, from sources other 
 31.24  than federal funds or funds used to match other federal 
 31.25  funds.  If the service is provided by a tribal agency, the 
 31.26  nonfederal share, if any, shall be provided by the recipient's 
 31.27  tribe.  
 31.28     (j) (k) The commissioner may suspend, reduce, or terminate 
 31.29  the reimbursement to a provider that does not meet the reporting 
 31.30  or other requirements of this section.  The county of 
 31.31  responsibility, as defined in sections 256G.01 to 256G.12, or, 
 31.32  if applicable, the tribal agency, is responsible for any federal 
 31.33  disallowances.  The county or tribe may share this 
 31.34  responsibility with its contracted vendors.  
 31.35     (k) (l) The commissioner shall set aside a portion of the 
 31.36  federal funds earned under this section to repay the special 
 32.1   revenue maximization account under section 256.01, subdivision 
 32.2   2, clause (15).  The repayment is limited to: 
 32.3      (1) the costs of developing and implementing this section; 
 32.4   and 
 32.5      (2) programming the information systems. 
 32.6      (l) (m) Notwithstanding section 256.025, subdivision 2, 
 32.7   payments to counties and tribal agencies for case management 
 32.8   expenditures under this section shall only be made from federal 
 32.9   earnings from services provided under this section.  Payments to 
 32.10  contracted county-contracted vendors shall include both the 
 32.11  federal earnings and the county share. 
 32.12     (m) (n) Notwithstanding section 256B.041, county payments 
 32.13  for the cost of mental health case management services provided 
 32.14  by county or state staff shall not be made to the state 
 32.15  treasurer.  For the purposes of mental health case management 
 32.16  services provided by county or state staff under this section, 
 32.17  the centralized disbursement of payments to counties under 
 32.18  section 256B.041 consists only of federal earnings from services 
 32.19  provided under this section. 
 32.20     (n) (o) Case management services under this subdivision do 
 32.21  not include therapy, treatment, legal, or outreach services. 
 32.22     (o) (p) If the recipient is a resident of a nursing 
 32.23  facility, intermediate care facility, or hospital, and the 
 32.24  recipient's institutional care is paid by medical assistance, 
 32.25  payment for case management services under this subdivision is 
 32.26  limited to the last 30 days of the recipient's residency in that 
 32.27  facility and may not exceed more than two months in a calendar 
 32.28  year. 
 32.29     (p) (q) Payment for case management services under this 
 32.30  subdivision shall not duplicate payments made under other 
 32.31  program authorities for the same purpose. 
 32.32     (q) (r) By July 1, 2000, the commissioner shall evaluate 
 32.33  the effectiveness of the changes required by this section, 
 32.34  including changes in number of persons receiving mental health 
 32.35  case management, changes in hours of service per person, and 
 32.36  changes in caseload size. 
 33.1      (r) (s) For each calendar year beginning with the calendar 
 33.2   year 2001, the annualized amount of state funds for each county 
 33.3   determined under paragraph (g) (h) shall be adjusted by the 
 33.4   county's percentage change in the average number of clients per 
 33.5   month who received case management under this section during the 
 33.6   fiscal year that ended six months prior to the calendar year in 
 33.7   question, in comparison to the prior fiscal year. 
 33.8      (s) (t) For counties receiving the minimum allocation of 
 33.9   $3,000 or $5,000 described in paragraph (g) (h), the adjustment 
 33.10  in paragraph (r) (s) shall be determined so that the county 
 33.11  receives the higher of the following amounts: 
 33.12     (1) a continuation of the minimum allocation in paragraph 
 33.13  (g) (h); or 
 33.14     (2) an amount based on that county's average number of 
 33.15  clients per month who received case management under this 
 33.16  section during the fiscal year that ended six months prior to 
 33.17  the calendar year in question, in comparison to the prior fiscal 
 33.18  year, times the average statewide grant per person per month for 
 33.19  counties not receiving the minimum allocation. 
 33.20     (t) (u) The adjustments in paragraphs (r) and (s) and (t) 
 33.21  shall be calculated separately for children and adults. 
 33.22     Sec. 8.  Minnesota Statutes 2000, section 256B.0625, is 
 33.23  amended by adding a subdivision to read: 
 33.24     Subd. 45.  [APPEAL PROCESS.] If a county contract or 
 33.25  certification is required to enroll as an authorized provider of 
 33.26  mental health services under medical assistance, and if a county 
 33.27  refuses to grant the necessary contract or certification, the 
 33.28  provider may appeal the county decision to the commissioner.  
 33.29  The commissioner shall determine whether the provider meets 
 33.30  applicable standards under state laws and rules based on an 
 33.31  independent review of the facts, including comments from the 
 33.32  county review.  If the commissioner finds that the provider 
 33.33  meets the applicable standards, the commissioner shall enroll 
 33.34  the provider as an authorized provider.