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; 256B.0625, subdivision 20, by 
  1.8             adding subdivisions; proposing coding for new law in 
  1.9             Minnesota Statutes, chapter 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.  Minnesota Statutes 2000, section 245.99, 
  2.17  subdivision 4, is amended to read: 
  2.18     Subd. 4.  [ADMINISTRATION OF CRISIS HOUSING ASSISTANCE.] 
  2.19  The commissioner may contract with organizations or government 
  2.20  units experienced in housing assistance to operate the program 
  2.21  under this section.  This program is not an entitlement.  The 
  2.22  commissioner may take any of the following steps whenever the 
  2.23  commissioner projects that funds will be inadequate to meet 
  2.24  demand in a given fiscal year: 
  2.25     (1) transfer funds from mental health grants in the same 
  2.26  appropriation; and 
  2.27     (2) impose statewide restrictions as to the type and amount 
  2.28  of assistance available to each recipient under this program, 
  2.29  including reducing the income eligibility level, limiting 
  2.30  reimbursement to a percentage of each recipient's costs, 
  2.31  limiting housing assistance to 60 days per recipient, or closing 
  2.32  the program for the remainder of the fiscal year. 
  2.33     Sec. 3.  Minnesota Statutes 2000, section 253.28, is 
  2.34  amended by adding a subdivision to read: 
  2.35     Subd. 1a.  [STATE-OPERATED SERVICES 
  2.36  AUTHORIZATION.] According to section 246.0136, the commissioner 
  3.1   of human services is authorized to implement, as an enterprise 
  3.2   activity, state-operated adult mental health services developed 
  3.3   for the purposes of preventing inpatient hospitalization or 
  3.4   facilitating the transition from hospital to community 
  3.5   placement, that qualify under the standards for adult mental 
  3.6   health rehabilitative services in section 256B.0623 and adult 
  3.7   mental health crisis response services in section 256B.0624, 
  3.8   once those options are incorporated as part of the approved 
  3.9   state medical assistance plan. 
  3.10     Sec. 4.  [256B.0623] [ADULT REHABILITATIVE MENTAL HEALTH 
  3.11  SERVICES.] 
  3.12     Subdivision 1.  [SCOPE.] Medical assistance covers adult 
  3.13  rehabilitative mental health services as defined in subdivision 
  3.14  2, subject to federal approval, if provided to recipients as 
  3.15  defined in subdivision 3 and provided by a qualified provider 
  3.16  entity meeting the standards in this section and by a qualified 
  3.17  individual provider working within the provider's scope of 
  3.18  practice and identified in the recipient's individual treatment 
  3.19  plan as defined in section 245.462, subdivision 14, and if 
  3.20  determined to be medically necessary according to section 62Q.53.
  3.21     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  3.22  following terms have the meanings given them. 
  3.23     (a) "Adult rehabilitative mental health services" means 
  3.24  mental health services which are rehabilitative and enable the 
  3.25  recipient to develop and enhance psychiatric stability, social 
  3.26  competencies, personal and emotional adjustment, and independent 
  3.27  living and community skills, when these abilities are impaired 
  3.28  by the symptoms of mental illness.  Adult rehabilitative mental 
  3.29  health services are also appropriate when provided to enable a 
  3.30  recipient to retain stability and functioning, if the recipient 
  3.31  would be at risk of significant functional decompensation or 
  3.32  more restrictive service settings without these services. 
  3.33     (1) Adult rehabilitative mental health services instruct, 
  3.34  assist, and support the recipient in areas such as:  
  3.35  interpersonal communication skills, community resource 
  3.36  utilization and integration skills, crisis assistance, relapse 
  4.1   prevention skills, health care directives, budgeting and 
  4.2   shopping skills, healthy lifestyle skills and practices, cooking 
  4.3   and nutrition skills, transportation skills, medication 
  4.4   education and monitoring, mental illness symptom management 
  4.5   skills, household management skills, employment-related skills, 
  4.6   and transition to community living services. 
  4.7      (2) These services shall be provided to the recipient on a 
  4.8   one-to-one basis in the recipient's home or another community 
  4.9   setting or in groups. 
  4.10     (b) "Medication education services" means services provided 
  4.11  individually or in groups which focus on educating the recipient 
  4.12  about mental illness and symptoms; the role and effects of 
  4.13  medications in treating symptoms of mental illness; and the side 
  4.14  effects of medications.  Medication education is coordinated 
  4.15  with medication management services, and does not duplicate it.  
  4.16  Medication education services are provided by physicians, 
  4.17  pharmacists, or registered nurses. 
  4.18     (c) "Transition to community living services" means 
  4.19  services which maintain continuity of contact between the 
  4.20  rehabilitation services provider and the recipient and which 
  4.21  facilitate discharge from a hospital, residential treatment 
  4.22  program under Minnesota Rules, chapter 9505, board and lodging 
  4.23  facility, or nursing home. Transition to community living 
  4.24  services are not intended to provide other areas of adult 
  4.25  rehabilitative mental health services.  
  4.26     Subd. 3.  [ELIGIBILITY.] An eligible recipient is an 
  4.27  individual who: 
  4.28     (1) is age 18 or older; 
  4.29     (2) is diagnosed with a medical condition, such as mental 
  4.30  illness or traumatic brain injury, for which adult 
  4.31  rehabilitative mental health services are needed; 
  4.32     (3) has substantial disability and functional impairment in 
  4.33  three or more of the areas listed in section 245.462, 
  4.34  subdivision 11a, so that self-sufficiency is markedly reduced; 
  4.35  and 
  4.36     (4) has had a recent diagnostic assessment by a qualified 
  5.1   professional that documents adult rehabilitative mental health 
  5.2   services are medically necessary to address identified 
  5.3   disability and functional impairments and individual recipient 
  5.4   goals. 
  5.5      Subd. 4.  [PROVIDER ENTITY STANDARDS.] (a) The provider 
  5.6   entity must be: 
  5.7      (1) a county operated entity certified by the state; or 
  5.8      (2) a noncounty entity certified by the entity's host 
  5.9   county. 
  5.10     (b) The certification process is a determination as to 
  5.11  whether the entity meets the standards in this subdivision.  The 
  5.12  certification must specify which adult rehabilitative mental 
  5.13  health services the entity is qualified to provide. 
  5.14     (c) If an entity seeks to provide services outside its host 
  5.15  county, it must obtain additional certification from each county 
  5.16  in which it will provide services.  The additional certification 
  5.17  must be based on the adequacy of the entity's knowledge of that 
  5.18  county's local health and human service system, and the ability 
  5.19  of the entity to coordinate its services with the other services 
  5.20  available in that county. 
  5.21     (d) Recertification must occur at least every two years. 
  5.22     (e) The commissioner may intervene at any time and 
  5.23  decertify providers with cause.  The decertification is subject 
  5.24  to appeal to the state.  A county board may recommend that the 
  5.25  state decertify a provider for cause. 
  5.26     (f) The adult rehabilitative mental health services 
  5.27  provider entity must meet the following standards: 
  5.28     (1) have capacity to recruit, hire, manage, and train 
  5.29  mental health professionals, mental health practitioners, and 
  5.30  mental health rehabilitation workers; 
  5.31     (2) have adequate administrative ability to ensure 
  5.32  availability of services; 
  5.33     (3) ensure adequate preservice and inservice training for 
  5.34  staff; 
  5.35     (4) ensure that mental health professionals, mental health 
  5.36  practitioners, and mental health rehabilitation workers are 
  6.1   skilled in the delivery of the specific adult rehabilitative 
  6.2   mental health services provided to the individual eligible 
  6.3   recipient; 
  6.4      (5) ensure that staff is capable of implementing culturally 
  6.5   specific services that are culturally competent and appropriate 
  6.6   as determined by the recipient's culture, beliefs, values, and 
  6.7   language as identified in the individual treatment plan; 
  6.8      (6) ensure enough flexibility in service delivery to 
  6.9   respond to the changing and intermittent care needs of a 
  6.10  recipient as identified by the recipient and the individual 
  6.11  treatment plan; 
  6.12     (7) ensure that the mental health professional or mental 
  6.13  health practitioner, who is under the clinical supervision of a 
  6.14  mental health professional, involved in a recipient's services 
  6.15  participates in the development of the individual treatment 
  6.16  plan; 
  6.17     (8) assist the recipient in arranging needed crisis 
  6.18  assessment, intervention, and stabilization services; 
  6.19     (9) ensure that services are coordinated with other 
  6.20  recipient mental health services providers and the county mental 
  6.21  health authority and the federally recognized American Indian 
  6.22  authority and necessary others after obtaining the consent of 
  6.23  the recipient.  Services must also be coordinated with the 
  6.24  recipient's case manager or care coordinator, if the recipient 
  6.25  is receiving case management or care coordination services; 
  6.26     (10) develop and maintain recipient files, individual 
  6.27  treatment plans, and contact charting; 
  6.28     (11) develop and maintain staff training and personnel 
  6.29  files; 
  6.30     (12) submit information as required by the state; 
  6.31     (13) establish and maintain a quality assurance plan to 
  6.32  evaluate the outcome of services provided; 
  6.33     (14) keep all necessary records required by law; 
  6.34     (15) deliver services as required by section 245.461; 
  6.35     (16) comply with all applicable laws; 
  6.36     (17) be an enrolled Medicaid provider; 
  7.1      (18) maintain a quality assurance plan to determine 
  7.2   specific service outcomes and the recipient's satisfaction with 
  7.3   services; and 
  7.4      (19) develop and maintain written policies and procedures 
  7.5   regarding service provision and administration of the provider 
  7.6   entity. 
  7.7      (g) The commissioner shall develop statewide procedures for 
  7.8   provider certification, including timelines for counties to 
  7.9   certify qualified providers. 
  7.10     Subd. 5.  [QUALIFICATIONS OF PROVIDER STAFF.] Adult 
  7.11  rehabilitative mental health services must be provided by 
  7.12  qualified individual provider staff of a certified provider 
  7.13  entity.  Individual provider staff must be qualified under one 
  7.14  of the following criteria: 
  7.15     (1) a mental health professional as defined in section 
  7.16  245.462, subdivision 18, clauses (1) to (5); 
  7.17     (2) a mental health practitioner as defined in section 
  7.18  245.462, subdivision 17.  The mental health practitioner must 
  7.19  work under the clinical supervision of a mental health 
  7.20  professional; or 
  7.21     (3) a mental health rehabilitation worker.  A mental health 
  7.22  rehabilitation worker means a staff person working under the 
  7.23  direction of a mental health practitioner or mental health 
  7.24  professional, and under the clinical supervision of a mental 
  7.25  health professional in the implementation of rehabilitative 
  7.26  mental health services as identified in the recipient's 
  7.27  individual treatment plan; and who: 
  7.28     (i) is at least 21 years of age; 
  7.29     (ii) has a high school diploma or equivalent; 
  7.30     (iii) has successfully completed 30 hours of training 
  7.31  during the past two years in all of the following areas:  
  7.32  recipient rights, recipient-centered individual treatment 
  7.33  planning, behavioral terminology, mental illness, co-occurring 
  7.34  mental illness and substance abuse, psychotropic medications and 
  7.35  side effects, functional assessment, local community resources, 
  7.36  adult vulnerability, recipient confidentiality; and 
  8.1      (iv) meets the qualifications in (A) or (B): 
  8.2      (A) has an associate of arts degree in one of the 
  8.3   behavioral sciences or human services, or is a registered nurse 
  8.4   without a bachelor's degree, or who within the previous ten 
  8.5   years has:  
  8.6      (1) three years of personal life experience with serious 
  8.7   and persistent mental illness; 
  8.8      (2) three years of life experience as a primary caregiver 
  8.9   to an adult with a serious mental illness or traumatic brain 
  8.10  injury; or 
  8.11     (3) 4,000 hours of supervised paid work experience in the 
  8.12  delivery of mental health services to adults with a serious 
  8.13  mental illness or traumatic brain injury; or 
  8.14     (B)(1) be fluent in the non-English language or competent 
  8.15  in the culture of the ethnic group to which at least 50 percent 
  8.16  of the mental health rehabilitation worker's clients belong; 
  8.17     (2) receives during the first 2,000 hours of work, monthly 
  8.18  documented individual clinical supervision by a mental health 
  8.19  professional; 
  8.20     (3) has 18 hours of documented field supervision by a 
  8.21  mental health professional or practitioner during the first 160 
  8.22  hours of contact work with recipients, and at least six hours of 
  8.23  field supervision quarterly during the following year; 
  8.24     (4) has review and cosignature of charting of recipient 
  8.25  contacts during field supervision by a mental health 
  8.26  professional or practitioner; and 
  8.27     (5) has 40 hours of additional continuing education on 
  8.28  mental health topics during the first year of employment. 
  8.29     Subd. 6.  [REQUIRED TRAINING AND SUPERVISION.] (a) Mental 
  8.30  health rehabilitation workers must receive ongoing continuing 
  8.31  education training of at least 30 hours every two years in areas 
  8.32  of mental illness and mental health services and other areas 
  8.33  specific to the population being served.  Mental health 
  8.34  rehabilitation workers must also be subject to the ongoing 
  8.35  direction and clinical supervision standards in paragraphs (c) 
  8.36  and (d). 
  9.1      (b) Mental health practitioners must receive ongoing 
  9.2   continuing education training as required by their professional 
  9.3   license; or if the practitioner is not licensed, the 
  9.4   practitioner must receive ongoing continuing education training 
  9.5   of at least 30 hours every two years in areas of mental illness 
  9.6   and mental health services.  Mental health practitioners must 
  9.7   meet the ongoing clinical supervision standards in paragraph (c).
  9.8      (c) A mental health professional providing clinical 
  9.9   supervision of staff delivering adult rehabilitative mental 
  9.10  health services must provide the following guidance: 
  9.11     (1) review the information in the recipient's file; 
  9.12     (2) review and approve initial and updates of individual 
  9.13  treatment plans; 
  9.14     (3) meet with mental health rehabilitation workers and 
  9.15  practitioners, individually or in small groups, at least monthly 
  9.16  to discuss treatment topics of interest to the workers and 
  9.17  practitioners; 
  9.18     (4) meet with mental health rehabilitation workers and 
  9.19  practitioners, individually or in small groups, at least monthly 
  9.20  to discuss treatment plans of recipients, and approve by 
  9.21  signature and document in the recipient's file any resulting 
  9.22  plan updates; 
  9.23     (5) meet at least twice a month with the directing mental 
  9.24  health practitioner, if there is one, to review needs of the 
  9.25  adult rehabilitative mental health services program, review 
  9.26  staff on-site observations and evaluate mental health 
  9.27  rehabilitation workers, plan staff training, review program 
  9.28  evaluation and development, and consult with the directing 
  9.29  practitioner; 
  9.30     (6) be available for urgent consultation as the individual 
  9.31  recipient needs or the situation necessitates; and 
  9.32     (7) provide clinical supervision by full- or part-time 
  9.33  mental health professionals employed by or under contract with 
  9.34  the provider entity. 
  9.35     (d) An adult rehabilitative mental health services provider 
  9.36  entity must have a treatment director who is a mental health 
 10.1   practitioner or mental health professional.  The treatment 
 10.2   director must ensure the following: 
 10.3      (1) while delivering direct services to recipients, a newly 
 10.4   hired mental health rehabilitation worker must be directly 
 10.5   observed delivering services to recipients by the mental health 
 10.6   practitioner or mental health professional for at least six 
 10.7   hours per 40 hours worked during the first 160 hours that the 
 10.8   mental health rehabilitation worker works; 
 10.9      (2) the mental health rehabilitation worker must receive 
 10.10  ongoing on-site direct service observation by a mental health 
 10.11  professional or mental health practitioner for at least six 
 10.12  hours for every six months of employment; 
 10.13     (3) progress notes are reviewed from on-site service 
 10.14  observation prepared by the mental health rehabilitation worker 
 10.15  and mental health practitioner for accuracy and consistency with 
 10.16  actual recipient contact and the individual treatment plan and 
 10.17  goals; 
 10.18     (4) immediate availability by phone or in person for 
 10.19  consultation by a mental health professional or a mental health 
 10.20  practitioner to the mental health rehabilitation services worker 
 10.21  during service provision; 
 10.22     (5) oversee the identification of changes in individual 
 10.23  recipient treatment strategies, revise the plan and communicate 
 10.24  treatment instructions and methodologies as appropriate to 
 10.25  ensure that treatment is implemented correctly; 
 10.26     (6) model service practices which:  respect the recipient, 
 10.27  include the recipient in planning and implementation of the 
 10.28  individual treatment plan, recognize the recipient's strengths, 
 10.29  collaborate and coordinate with other involved parties and 
 10.30  providers; 
 10.31     (7) ensure that mental health practitioners and mental 
 10.32  health rehabilitation workers are able to effectively 
 10.33  communicate with the recipients, significant others, and 
 10.34  providers; and 
 10.35     (8) oversee the record of the results of on-site 
 10.36  observation and charting evaluation and corrective actions taken 
 11.1   to modify the work of the mental health practitioners and mental 
 11.2   health rehabilitation workers. 
 11.3      (e) A mental health practitioner who is providing treatment 
 11.4   direction for a provider entity must receive supervision at 
 11.5   least monthly from a mental health professional to: 
 11.6      (1) identify and plan for general needs of the recipient 
 11.7   population served; 
 11.8      (2) identify and plan to address provider entity program 
 11.9   needs and effectiveness; 
 11.10     (3) identify and plan provider entity staff training and 
 11.11  personnel needs and issues; and 
 11.12     (4) plan, implement, and evaluate provider entity quality 
 11.13  improvement programs.  
 11.14     Subd. 7.  [PERSONNEL FILE.] The adult rehabilitative mental 
 11.15  health services provider entity must maintain a personnel file 
 11.16  on each staff.  Each file must contain: 
 11.17     (1) an annual performance review; 
 11.18     (2) a summary of on-site service observations and charting 
 11.19  review; 
 11.20     (3) a criminal background check of all direct service 
 11.21  staff; 
 11.22     (4) evidence of academic degree and qualifications; 
 11.23     (5) a copy of professional license; 
 11.24     (6) any job performance recognition and disciplinary 
 11.25  actions; 
 11.26     (7) any individual staff written input into own personnel 
 11.27  file; 
 11.28     (8) all clinical supervision provided; and 
 11.29     (9) documentation of compliance with continuing education 
 11.30  requirements. 
 11.31     Subd. 8.  [DIAGNOSTIC ASSESSMENT.] Providers of adult 
 11.32  rehabilitative mental health services must complete a diagnostic 
 11.33  assessment as defined in section 245.462, subdivision 9, within 
 11.34  five days after the recipient's second visit or within 30 days 
 11.35  after intake, whichever occurs first.  In cases where a 
 11.36  diagnostic assessment is available that reflects the recipient's 
 12.1   current status, and has been completed within 180 days preceding 
 12.2   admission, an update must be completed.  An update shall include 
 12.3   a written summary by a mental health professional of the 
 12.4   recipient's current mental health status and service needs.  If 
 12.5   the recipient's mental health status has changed significantly 
 12.6   since the adult's most recent diagnostic assessment, a new 
 12.7   diagnostic assessment is required. 
 12.8      Subd. 9.  [FUNCTIONAL ASSESSMENT.] Providers of adult 
 12.9   rehabilitative mental health services must complete a written 
 12.10  functional assessment as defined in section 245.462, subdivision 
 12.11  11a, for each recipient.  The functional assessment must be 
 12.12  completed within 30 days of intake, and reviewed and updated at 
 12.13  least every six months after it is developed, unless there is a 
 12.14  significant change in the functioning of the recipient.  If 
 12.15  there is a significant change in functioning, the assessment 
 12.16  must be updated.  A single functional assessment can meet case 
 12.17  management and adult rehabilitative mental health services 
 12.18  requirements, if agreed to by the recipient.  Unless the 
 12.19  recipient refuses, the recipient must have significant 
 12.20  participation in the development of the functional assessment. 
 12.21     Subd. 10.  [INDIVIDUAL TREATMENT PLAN.] All providers of 
 12.22  adult rehabilitative mental health services must develop and 
 12.23  implement an individual treatment plan for each recipient.  The 
 12.24  provisions in clauses (1) and (2) apply: 
 12.25     (1) Individual treatment plan means a plan of intervention, 
 12.26  treatment, and services for an individual recipient written by a 
 12.27  mental health professional or by a mental health practitioner 
 12.28  under the clinical supervision of a mental health professional.  
 12.29  The individual treatment plan must be based on diagnostic and 
 12.30  functional assessments.  To the extent possible, the development 
 12.31  and implementation of a treatment plan must be a collaborative 
 12.32  process involving the recipient, and with the permission of the 
 12.33  recipient, the recipient's family and others in the recipient's 
 12.34  support system.  Providers of adult rehabilitative mental health 
 12.35  services must develop the individual treatment plan within 30 
 12.36  calendar days of intake.  The treatment plan must be updated at 
 13.1   least every six months thereafter, or more often when there is 
 13.2   significant change in the recipient's situation or functioning, 
 13.3   or in services or service methods to be used, or at the request 
 13.4   of the recipient or the recipient's legal guardian. 
 13.5      (2) The individual treatment plan must include: 
 13.6      (i) a list of problems identified in the assessment; 
 13.7      (ii) the recipient's strengths and resources; 
 13.8      (iii) concrete, measurable goals to be achieved, including 
 13.9   time frames for achievement; 
 13.10     (iv) specific objectives directed toward the achievement of 
 13.11  each one of the goals; 
 13.12     (v) documentation of participants in the treatment planning.
 13.13  The recipient, if possible, must be a participant.  The 
 13.14  recipient or the recipient's legal guardian must sign the 
 13.15  treatment plan, or documentation must be provided why this was 
 13.16  not possible.  A copy of the plan must be given to the recipient 
 13.17  or legal guardian.  Referral to formal services must be 
 13.18  arranged, including specific providers where applicable; 
 13.19     (vi) cultural considerations, resources, and needs of the 
 13.20  recipient must be included; 
 13.21     (vii) planned frequency and type of services must be 
 13.22  initiated; and 
 13.23     (viii) clear progress notes on outcome of goals. 
 13.24     (3) The individual community support plan defined in 
 13.25  section 245.462, subdivision 12, may serve as the individual 
 13.26  treatment plan if there is involvement of a mental health case 
 13.27  manager, and with the approval of the recipient.  The individual 
 13.28  community support plan must include the criteria in clause (2). 
 13.29     Subd. 11.  [RECIPIENT FILE.] Providers of adult 
 13.30  rehabilitative mental health services must maintain a file for 
 13.31  each recipient that contains the following information: 
 13.32     (1) diagnostic assessment or verification of its location, 
 13.33  that is current and that was reviewed by a mental health 
 13.34  professional who is employed by or under contract with the 
 13.35  provider entity; 
 13.36     (2) functional assessments; 
 14.1      (3) individual treatment plans signed by the recipient and 
 14.2   the mental health professional, or if the recipient refused to 
 14.3   sign the plan, the date and reason stated by the recipient as to 
 14.4   why the recipient would not sign the plan; 
 14.5      (4) recipient history; 
 14.6      (5) signed release forms; 
 14.7      (6) recipient health information and current medications; 
 14.8      (7) emergency contacts for the recipient; 
 14.9      (8) case records which document the date of service, the 
 14.10  place of service delivery, signature of the person providing the 
 14.11  service, nature, extent and units of service, and place of 
 14.12  service delivery; 
 14.13     (9) contacts, direct or by telephone, with recipient's 
 14.14  family or others, other providers, or other resources for 
 14.15  service coordination; 
 14.16     (10) summary of recipient case reviews by staff; and 
 14.17     (11) written information by the recipient that the 
 14.18  recipient requests be included in the file. 
 14.19     Subd. 12.  [ADDITIONAL REQUIREMENTS.] (a) Providers of 
 14.20  adult rehabilitative mental health services must comply with the 
 14.21  requirements relating to referrals for case management in 
 14.22  section 245.467, subdivision 4. 
 14.23     (b) Adult rehabilitative mental health services are 
 14.24  provided for most recipients in the recipient's home and 
 14.25  community.  Services may also be provided at the home of a 
 14.26  relative or significant other, job site, psychosocial clubhouse, 
 14.27  drop-in center, social setting, classroom, or other places in 
 14.28  the community.  Except for "transition to community services," 
 14.29  the place of service does not include a regional treatment 
 14.30  center, nursing home, residential treatment facility licensed 
 14.31  under Minnesota Rules, parts 9520.0500 to 9520.0670 (Rule 36), 
 14.32  or an acute care hospital. 
 14.33     (c) Adult rehabilitative mental health services may be 
 14.34  provided in group settings if appropriate to each participating 
 14.35  recipient's needs and treatment plan.  A group is defined as two 
 14.36  to ten clients, at least one of whom is a recipient, who is 
 15.1   concurrently receiving a service which is identified in this 
 15.2   section.  The service and group must be specified in the 
 15.3   recipient's treatment plan.  No more than two qualified staff 
 15.4   may bill Medicaid for services provided to the same group of 
 15.5   recipients.  If two adult rehabilitative mental health workers 
 15.6   bill for recipients in the same group session, they must each 
 15.7   bill for different recipients. 
 15.8      Subd. 13.  [EXCLUDED SERVICES.] The following services are 
 15.9   excluded from reimbursement as adult rehabilitative mental 
 15.10  health services: 
 15.11     (1) recipient transportation services; 
 15.12     (2) a service provided and billed by a provider who is not 
 15.13  enrolled to provide adult rehabilitative mental health service; 
 15.14     (3) adult rehabilitative mental health services performed 
 15.15  by volunteers; 
 15.16     (4) provider performance of household tasks, chores, or 
 15.17  related activities, such as laundering clothes, moving the 
 15.18  recipient's household, housekeeping, and grocery shopping for 
 15.19  the recipient; 
 15.20     (5) direct billing of time spent "on call" when not 
 15.21  delivering services to recipients; 
 15.22     (6) activities which are primarily social or recreational 
 15.23  in nature, rather than rehabilitative, for the individual 
 15.24  recipient, as determined by the individual's needs and treatment 
 15.25  plan; 
 15.26     (7) job-specific skills services, such as on-the-job 
 15.27  training; 
 15.28     (8) provider service time included in case management 
 15.29  reimbursement; 
 15.30     (9) outreach services to potential recipients; 
 15.31     (10) a mental health service that is not medically 
 15.32  necessary; and 
 15.33     (11) any services provided by a hospital, board and 
 15.34  lodging, or residential facility to an individual who is a 
 15.35  patient in or resident of that facility. 
 15.36     Subd. 14.  [BILLING WHEN SERVICES ARE PROVIDED BY QUALIFIED 
 16.1   STATE STAFF.] When rehabilitative services are provided by 
 16.2   qualified state staff who are assigned to pilot projects under 
 16.3   section 245.4661, the county or other local entity to which the 
 16.4   qualified state staff are assigned may consider these staff part 
 16.5   of the local provider entity for which certification is sought 
 16.6   under this section, and may bill the medical assistance program 
 16.7   for qualifying services provided by the qualified state staff.  
 16.8   Notwithstanding section 256.025, subdivision 2, payments for 
 16.9   services provided by state staff who are assigned to adult 
 16.10  mental health initiatives shall only be made from federal funds. 
 16.11     Sec. 5.  [256B.0624] [ADULT MENTAL HEALTH CRISIS RESPONSE 
 16.12  SERVICES.] 
 16.13     Subdivision 1.  [SCOPE.] Medical assistance covers adult 
 16.14  mental health crisis response services as defined in subdivision 
 16.15  2, paragraphs (c) to (e), subject to federal approval, if 
 16.16  provided to a recipient as defined in subdivision 3 and provided 
 16.17  by a qualified provider entity as defined in this section and by 
 16.18  a qualified individual provider working within the provider's 
 16.19  scope of practice and as defined in this subdivision and 
 16.20  identified in the recipient's individual crisis treatment plan 
 16.21  as defined in subdivisions 10 and 13 and if determined to be 
 16.22  medically necessary.  
 16.23     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
 16.24  following terms have the meanings given them. 
 16.25     (a) "Mental health crisis" is an adult behavioral, 
 16.26  emotional, or psychiatric situation which, but for the provision 
 16.27  of crisis response services, would likely result in 
 16.28  significantly reduced levels of functioning in primary 
 16.29  activities of daily living, or in an emergency situation, or in 
 16.30  the placement of the recipient in a more restrictive setting, 
 16.31  including, but not limited to, inpatient hospitalization.  
 16.32     (b) "Mental health emergency" is an adult behavioral, 
 16.33  emotional, or psychiatric situation which causes an immediate 
 16.34  need for mental health services and is consistent with section 
 16.35  62Q.55. 
 16.36     A mental health crisis or emergency is determined for 
 17.1   medical assistance service reimbursement by a physician, a 
 17.2   mental health professional, or crisis mental health practitioner 
 17.3   with input from the recipient whenever possible. 
 17.4      (c) "Mental health crisis assessment" means an immediate 
 17.5   face-to-face assessment by a physician, a mental health 
 17.6   professional, or mental health practitioner under the clinical 
 17.7   supervision of a mental health professional, following a 
 17.8   screening that suggests that the adult may be experiencing a 
 17.9   mental health crisis or mental health emergency situation. 
 17.10     (d) "Mental health mobile crisis intervention services" 
 17.11  means face-to-face, short-term intensive mental health services 
 17.12  initiated during a mental health crisis or mental health 
 17.13  emergency to help the recipient cope with immediate stressors, 
 17.14  identify and utilize available resources and strengths, and 
 17.15  begin to return to the recipient's baseline level of functioning.
 17.16     (1) This service is provided on-site by a mobile crisis 
 17.17  intervention team outside of an inpatient hospital setting.  
 17.18  Mental health mobile crisis intervention services must be 
 17.19  available 24 hours a day, seven days a week.  
 17.20     (2) The initial screening must consider other available 
 17.21  services to determine which service intervention would best 
 17.22  address the recipient's needs and circumstances.  
 17.23     (3) The mobile crisis intervention team must be available 
 17.24  to meet promptly face-to-face with a person in mental health 
 17.25  crisis or emergency in a community setting.  
 17.26     (4) The intervention must consist of a mental health crisis 
 17.27  assessment and a crisis treatment plan.  
 17.28     (5) The treatment plan must include recommendations for any 
 17.29  needed crisis stabilization services for the recipient. 
 17.30     (e) "Mental health crisis stabilization services" means 
 17.31  individualized mental health services provided to a recipient 
 17.32  following crisis intervention services, which are designed to 
 17.33  restore the recipient to the recipient's prior functional 
 17.34  level.  Mental health crisis stabilization services may be 
 17.35  provided in the recipient's home, the home of a family member or 
 17.36  friend of the recipient, another community setting, or a 
 18.1   short-term supervised, licensed residential program.  Mental 
 18.2   health crisis stabilization does not include partial 
 18.3   hospitalization or day treatment. 
 18.4      Subd. 3.  [ELIGIBILITY.] An eligible recipient is an 
 18.5   individual who: 
 18.6      (1) is age 18 or older; 
 18.7      (2) is screened as possibly experiencing a mental health 
 18.8   crisis or emergency where a mental health crisis assessment is 
 18.9   needed; and 
 18.10     (3) is assessed as experiencing a mental health crisis or 
 18.11  emergency, and mental health crisis intervention or crisis 
 18.12  intervention and stabilization services are determined to be 
 18.13  medically necessary.  
 18.14     Subd. 4.  [PROVIDER ENTITY STANDARDS.] (a) A provider 
 18.15  entity is an entity that meets the standards listed in paragraph 
 18.16  (b) and: 
 18.17     (1) is a county board operated entity; or 
 18.18     (2) is a provider entity that is under contract with the 
 18.19  county board in the county where the potential crisis or 
 18.20  emergency is occurring.  To provide services under this section, 
 18.21  the provider entity must directly provide the services; or if 
 18.22  services are subcontracted, the provider entity must maintain 
 18.23  responsibility for services and billing. 
 18.24     (b) The adult mental health crisis response services 
 18.25  provider entity must meet the following standards: 
 18.26     (1) has the capacity to recruit, hire, and manage and train 
 18.27  mental health professionals, practitioners, and rehabilitation 
 18.28  workers; 
 18.29     (2) has adequate administrative ability to ensure 
 18.30  availability of services; 
 18.31     (3) is able to ensure adequate preservice and in-service 
 18.32  training; 
 18.33     (4) is able to ensure that staff providing these services 
 18.34  are skilled in the delivery of mental health crisis response 
 18.35  services to recipients; 
 18.36     (5) is able to ensure that staff are capable of 
 19.1   implementing culturally specific treatment identified in the 
 19.2   individual treatment plan that is meaningful and appropriate as 
 19.3   determined by the recipient's culture, beliefs, values, and 
 19.4   language; 
 19.5      (6) is able to ensure enough flexibility to respond to the 
 19.6   changing intervention and care needs of a recipient as 
 19.7   identified by the recipient during the service partnership 
 19.8   between the recipient and providers; 
 19.9      (7) is able to ensure that mental health professionals and 
 19.10  mental health practitioners have the communication tools and 
 19.11  procedures to communicate and consult promptly about crisis 
 19.12  assessment and interventions as services occur; 
 19.13     (8) is able to coordinate these services with county 
 19.14  emergency services and mental health crisis services; 
 19.15     (9) is able to ensure that mental health crisis assessment 
 19.16  and mobile crisis intervention services are available 24 hours a 
 19.17  day, seven days a week; 
 19.18     (10) is able to ensure that services are coordinated with 
 19.19  other mental health service providers, county mental health 
 19.20  authorities, or federally recognized American Indian authorities 
 19.21  and others as necessary, with the consent of the adult.  
 19.22  Services must also be coordinated with the recipient's case 
 19.23  manager if the adult is receiving case management services; 
 19.24     (11) is able to ensure that crisis intervention services 
 19.25  are provided in a manner consistent with sections 245.461 to 
 19.26  245.486; 
 19.27     (12) is able to submit information as required by the 
 19.28  state; 
 19.29     (13) maintains staff training and personnel files; 
 19.30     (14) is able to establish and maintain a quality assurance 
 19.31  and evaluation plan to evaluate the outcomes of services and 
 19.32  recipient satisfaction; 
 19.33     (15) is able to keep records as required by applicable 
 19.34  laws; 
 19.35     (16) is able to comply with all applicable laws and 
 19.36  statutes; 
 20.1      (17) is an enrolled medical assistance provider; and 
 20.2      (18) develops and maintains written policies and procedures 
 20.3   regarding service provision and administration of the provider 
 20.4   entity, including safety of staff and recipients in high-risk 
 20.5   situations.  
 20.6      Subd. 5.  [MOBILE CRISIS INTERVENTION STAFF 
 20.7   QUALIFICATIONS.] For provision of adult mental health mobile 
 20.8   crisis intervention services, a mobile crisis intervention team 
 20.9   is comprised of at least two mental health professionals as 
 20.10  defined in section 245.462, subdivision 18, clauses (1) to (5), 
 20.11  or a combination of at least one mental health professional and 
 20.12  one mental health practitioner as defined in section 245.462, 
 20.13  subdivision 17, with the required mental health crisis training 
 20.14  and under the clinical supervision of a mental health 
 20.15  professional on the team.  The team must have at least two 
 20.16  people with at least one member providing on-site crisis 
 20.17  intervention services when needed.  Team members must be 
 20.18  experienced in mental health assessment, crisis intervention 
 20.19  techniques, and clinical decision-making under emergency 
 20.20  conditions and have knowledge of local services and resources.  
 20.21  The team must recommend and coordinate the team's services with 
 20.22  appropriate local resources such as the county social services 
 20.23  agency, mental health services, and local law enforcement when 
 20.24  necessary. 
 20.25     Subd. 6.  [INITIAL SCREENING, CRISIS ASSESSMENT, AND MOBILE 
 20.26  INTERVENTION TREATMENT PLANNING.] (a) Prior to initiating mobile 
 20.27  crisis intervention services, a screening of the potential 
 20.28  crisis situation must be conducted.  The screening may use the 
 20.29  resources of crisis assistance and emergency services as defined 
 20.30  in sections 245.462, subdivision 6, and 245.469, subdivisions 1 
 20.31  and 2.  The screening must gather information, determine whether 
 20.32  a crisis situation exists, identify parties involved, and 
 20.33  determine an appropriate response. 
 20.34     (b) If a crisis exists, a crisis assessment must be 
 20.35  completed.  A crisis assessment evaluates any immediate needs 
 20.36  for which emergency services are needed and, as time permits, 
 21.1   the recipient's current life situation, sources of stress, 
 21.2   mental health problems and symptoms, strengths, cultural 
 21.3   considerations, support network, vulnerabilities, and current 
 21.4   functioning. 
 21.5      (c) If the crisis assessment determines mobile crisis 
 21.6   intervention services are needed, the intervention services must 
 21.7   be provided promptly.  As opportunity presents during the 
 21.8   intervention, at least two members of the mobile crisis 
 21.9   intervention team must confer directly or by telephone about the 
 21.10  assessment, treatment plan, and actions taken and needed.  At 
 21.11  least one of the team members must be on site providing crisis 
 21.12  intervention services.  If providing on-site crisis intervention 
 21.13  services, a mental health practitioner must seek clinical 
 21.14  supervision as required in subdivision 9. 
 21.15     (d) The mobile crisis intervention team must develop an 
 21.16  initial, brief crisis treatment plan as soon as appropriate but 
 21.17  no later than 24 hours after the initial face-to-face 
 21.18  intervention.  The plan must address the needs and problems 
 21.19  noted in the crisis assessment and include measurable short-term 
 21.20  goals, cultural considerations, and frequency and type of 
 21.21  services to be provided to achieve the goals and reduce or 
 21.22  eliminate the crisis.  The treatment plan must be updated as 
 21.23  needed to reflect current goals and services. 
 21.24     (e) The team must document which short-term goals have been 
 21.25  met, and when no further crisis intervention services are 
 21.26  required. 
 21.27     (f) If the recipient's crisis is stabilized, but the 
 21.28  recipient needs a referral to other services, the team must 
 21.29  provide referrals to these services.  If the recipient has a 
 21.30  case manager, planning for other services must be coordinated 
 21.31  with the case manager. 
 21.32     Subd. 7.  [CRISIS STABILIZATION SERVICES.] (a) Crisis 
 21.33  stabilization services must be provided by qualified staff of a 
 21.34  crisis stabilization services provider entity and must meet the 
 21.35  following standards: 
 21.36     (1) a crisis stabilization treatment plan must be developed 
 22.1   which meets the criteria in subdivision 11; 
 22.2      (2) staff must be qualified as defined in subdivision 8; 
 22.3   and 
 22.4      (3) services must be delivered according to the treatment 
 22.5   plan and include face-to-face contact with the recipient by 
 22.6   qualified staff for further assessment, help with referrals, 
 22.7   updating of the crisis stabilization treatment plan, supportive 
 22.8   counseling, skills training, and collaboration with other 
 22.9   service providers in the community. 
 22.10     (b) If crisis stabilization services are provided in a 
 22.11  supervised, licensed residential setting, the recipient must be 
 22.12  contacted face-to-face daily by a qualified mental health 
 22.13  practitioner or mental health professional.  The program must 
 22.14  have 24-hour-a-day residential staffing which may include staff 
 22.15  who do not meet the qualifications in subdivision 8.  The 
 22.16  residential staff must have 24-hour-a-day immediate direct or 
 22.17  telephone access to a qualified mental health professional or 
 22.18  practitioner. 
 22.19     (c) If crisis stabilization services are provided in a 
 22.20  supervised, licensed residential setting that serves no more 
 22.21  than four adult residents, and no more than two are recipients 
 22.22  of crisis stabilization services, the residential staff must 
 22.23  include, for at least eight hours per day, at least one 
 22.24  individual who meets the qualifications in subdivision 8. 
 22.25     (d) If crisis stabilization services are provided in a 
 22.26  supervised, licensed residential setting that serves more than 
 22.27  four adult residents, and one or more are recipients of crisis 
 22.28  stabilization services, the residential staff must include, for 
 22.29  24 hours per day, at least one individual who meets the 
 22.30  qualifications in subdivision 8.  During the first 48 hours that 
 22.31  a recipient is in the residential program, the residential 
 22.32  program must have at least two staff working 24 hours a day.  
 22.33  Staffing levels may be adjusted thereafter according to the 
 22.34  needs of the recipient as specified in the crisis stabilization 
 22.35  treatment plan. 
 22.36     Subd. 8.  [ADULT CRISIS STABILIZATION STAFF 
 23.1   QUALIFICATIONS.] (a) Adult mental health crisis stabilization 
 23.2   services must be provided by qualified individual staff of a 
 23.3   qualified provider entity.  Individual provider staff must have 
 23.4   the following qualifications: 
 23.5      (1) be a mental health professional as defined in section 
 23.6   245.462, subdivision 18, clauses (1) to (5); 
 23.7      (2) be a mental health practitioner as defined in section 
 23.8   245.462, subdivision 17.  The mental health practitioner must 
 23.9   work under the clinical supervision of a mental health 
 23.10  professional; or 
 23.11     (3) be a mental health rehabilitation worker who meets the 
 23.12  criteria in section 256B.0623, subdivision 5, clause (3); works 
 23.13  under the direction of a mental health practitioner as defined 
 23.14  in section 245.462, subdivision 17, or under direction of a 
 23.15  mental health professional; and works under the clinical 
 23.16  supervision of a mental health professional. 
 23.17     (b) Mental health practitioners and mental health 
 23.18  rehabilitation workers must have completed at least 30 hours of 
 23.19  training in crisis intervention and stabilization during the 
 23.20  past two years. 
 23.21     Subd. 9.  [SUPERVISION.] Mental health practitioners may 
 23.22  provide crisis assessment and mobile crisis intervention 
 23.23  services if the following clinical supervision requirements are 
 23.24  met: 
 23.25     (1) the mental health provider entity must accept full 
 23.26  responsibility for the services provided; 
 23.27     (2) the mental health professional of the provider entity, 
 23.28  who is an employee or under contract with the provider entity, 
 23.29  must be immediately available by phone or in person for clinical 
 23.30  supervision; 
 23.31     (3) the mental health professional is consulted, in person 
 23.32  or by phone, during the first three hours when a mental health 
 23.33  practitioner provides on-site service; 
 23.34     (4) the mental health professional must: 
 23.35     (i) review and approve of the tentative crisis assessment 
 23.36  and crisis treatment plan; 
 24.1      (ii) document the consultation; and 
 24.2      (iii) sign the crisis assessment and treatment plan within 
 24.3   the next business day; 
 24.4      (5) if the mobile crisis intervention services continue 
 24.5   into a second calendar day, a mental health professional must 
 24.6   contact the recipient face-to-face on the second day to provide 
 24.7   services and update the crisis treatment plan; and 
 24.8      (6) the on-site observation must be documented in the 
 24.9   recipient's record and signed by the mental health professional. 
 24.10     Subd. 10.  [RECIPIENT FILE.] Providers of mobile crisis 
 24.11  intervention or crisis stabilization services must maintain a 
 24.12  file for each recipient containing the following information: 
 24.13     (1) individual crisis treatment plans signed by the 
 24.14  recipient, mental health professional, and mental health 
 24.15  practitioner who developed the crisis treatment plan, or if the 
 24.16  recipient refused to sign the plan, the date and reason stated 
 24.17  by the recipient as to why the recipient would not sign the 
 24.18  plan; 
 24.19     (2) signed release forms; 
 24.20     (3) recipient health information and current medications; 
 24.21     (4) emergency contacts for the recipient; 
 24.22     (5) case records which document the date of service, place 
 24.23  of service delivery, signature of the person providing the 
 24.24  service, and the nature, extent, and units of service.  Direct 
 24.25  or telephone contact with the recipient's family or others 
 24.26  should be documented; 
 24.27     (6) required clinical supervision by mental health 
 24.28  professionals; 
 24.29     (7) summary of the recipient's case reviews by staff; and 
 24.30     (8) any written information by the recipient that the 
 24.31  recipient wants in the file. 
 24.32  Documentation in the file must comply with all requirements of 
 24.33  the commissioner. 
 24.34     Subd. 11.  [TREATMENT PLAN.] The individual crisis 
 24.35  stabilization treatment plan must include, at a minimum: 
 24.36     (1) a list of problems identified in the assessment; 
 25.1      (2) a list of the recipient's strengths and resources; 
 25.2      (3) concrete, measurable short-term goals and tasks to be 
 25.3   achieved, including time frames for achievement; 
 25.4      (4) specific objectives directed toward the achievement of 
 25.5   each one of the goals; 
 25.6      (5) documentation of the participants involved in the 
 25.7   service planning.  The recipient, if possible, must be a 
 25.8   participant.  The recipient or the recipient's legal guardian 
 25.9   must sign the service plan or documentation must be provided why 
 25.10  this was not possible.  A copy of the plan must be given to the 
 25.11  recipient and the recipient's legal guardian.  The plan should 
 25.12  include services arranged, including specific providers where 
 25.13  applicable; 
 25.14     (6) planned frequency and type of services initiated; 
 25.15     (7) a crisis response action plan if a crisis should occur; 
 25.16     (8) clear progress notes on outcome of goals; 
 25.17     (9) a written plan must be completed within 24 hours of 
 25.18  beginning services with the recipient; and 
 25.19     (10) a treatment plan must be developed by a mental health 
 25.20  professional or mental health practitioner under the clinical 
 25.21  supervision of a mental health professional.  The mental health 
 25.22  professional must approve and sign all treatment plans. 
 25.23     Subd. 12.  [EXCLUDED SERVICES.] The following services are 
 25.24  excluded from reimbursement under this section: 
 25.25     (1) room and board services; 
 25.26     (2) services delivered to a recipient while admitted to an 
 25.27  inpatient hospital; 
 25.28     (3) recipient transportation costs may be covered under 
 25.29  other medical assistance provisions, but transportation services 
 25.30  are not an adult mental health crisis response service; 
 25.31     (4) services provided and billed by a provider who is not 
 25.32  enrolled under medical assistance to provide adult mental health 
 25.33  crisis response services; 
 25.34     (5) services performed by volunteers; 
 25.35     (6) direct billing of time spent "on call" when not 
 25.36  delivering services to a recipient; 
 26.1      (7) provider service time included in case management 
 26.2   reimbursement.  When a provider is eligible to provide more than 
 26.3   one type of medical assistance service, the recipient must have 
 26.4   a choice of provider for each service, unless otherwise provided 
 26.5   for by law; 
 26.6      (8) outreach services to potential recipients; and 
 26.7      (9) a mental health service that is not medically necessary.
 26.8      Sec. 6.  Minnesota Statutes 2000, section 256B.0625, 
 26.9   subdivision 20, is amended to read: 
 26.10     Subd. 20.  [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 
 26.11  extent authorized by rule of the state agency, medical 
 26.12  assistance covers case management services to persons with 
 26.13  serious and persistent mental illness and children with severe 
 26.14  emotional disturbance.  Services provided under this section 
 26.15  must meet the relevant standards in sections 245.461 to 
 26.16  245.4888, the Comprehensive Adult and Children's Mental Health 
 26.17  Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 
 26.18  9505.0322, excluding subpart 10. 
 26.19     (b) Entities meeting program standards set out in rules 
 26.20  governing family community support services as defined in 
 26.21  section 245.4871, subdivision 17, are eligible for medical 
 26.22  assistance reimbursement for case management services for 
 26.23  children with severe emotional disturbance when these services 
 26.24  meet the program standards in Minnesota Rules, parts 9520.0900 
 26.25  to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 
 26.26     (c) Medical assistance and MinnesotaCare payment for mental 
 26.27  health case management shall be made on a monthly basis.  In 
 26.28  order to receive payment for an eligible child, the provider 
 26.29  must document at least a face-to-face contact with the child, 
 26.30  the child's parents, or the child's legal representative.  To 
 26.31  receive payment for an eligible adult, the provider must 
 26.32  document: 
 26.33     (1) at least a face-to-face contact with the adult or the 
 26.34  adult's legal representative; or 
 26.35     (2) at least a telephone contact with the adult or the 
 26.36  adult's legal representative and document a face-to-face contact 
 27.1   with the adult or the adult's legal representative within the 
 27.2   preceding two months. 
 27.3      (d) Payment for mental health case management provided by 
 27.4   county or state staff shall be based on the monthly rate 
 27.5   methodology under section 256B.094, subdivision 6, paragraph 
 27.6   (b), with separate rates calculated for child welfare and mental 
 27.7   health, and within mental health, separate rates for children 
 27.8   and adults. 
 27.9      (e) Payment for mental health case management provided by 
 27.10  Indian health services or by agencies operated by Indian tribes 
 27.11  may be made according to this section or other relevant 
 27.12  federally approved rate setting methodology. 
 27.13     (f) Payment for mental health case management provided by 
 27.14  county-contracted vendors who contract with a county or Indian 
 27.15  tribe shall be based on a monthly rate negotiated by the host 
 27.16  county or tribe.  The negotiated rate must not exceed the rate 
 27.17  charged by the vendor for the same service to other payers.  If 
 27.18  the service is provided by a team of contracted vendors, the 
 27.19  county or tribe may negotiate a team rate with a vendor who is a 
 27.20  member of the team.  The team shall determine how to distribute 
 27.21  the rate among its members.  No reimbursement received by 
 27.22  contracted vendors shall be returned to the county or tribe, 
 27.23  except to reimburse the county or tribe for advance funding 
 27.24  provided by the county or tribe to the vendor. 
 27.25     (f) (g) If the service is provided by a team which includes 
 27.26  contracted vendors, tribal staff, and county or state staff, the 
 27.27  costs for county or state staff participation in the team shall 
 27.28  be included in the rate for county-provided services.  In this 
 27.29  case, the contracted vendor, the tribal agency, and the county 
 27.30  may each receive separate payment for services provided by each 
 27.31  entity in the same month.  In order to prevent duplication of 
 27.32  services, the county each entity must document, in the 
 27.33  recipient's file, the need for team case management and a 
 27.34  description of the roles of the team members. 
 27.35     (g) (h) The commissioner shall calculate the nonfederal 
 27.36  share of actual medical assistance and general assistance 
 28.1   medical care payments for each county, based on the higher of 
 28.2   calendar year 1995 or 1996, by service date, project that amount 
 28.3   forward to 1999, and transfer one-half of the result from 
 28.4   medical assistance and general assistance medical care to each 
 28.5   county's mental health grants under sections 245.4886 and 
 28.6   256E.12 for calendar year 1999.  The annualized minimum amount 
 28.7   added to each county's mental health grant shall be $3,000 per 
 28.8   year for children and $5,000 per year for adults.  The 
 28.9   commissioner may reduce the statewide growth factor in order to 
 28.10  fund these minimums.  The annualized total amount transferred 
 28.11  shall become part of the base for future mental health grants 
 28.12  for each county. 
 28.13     (h) (i) Any net increase in revenue to the county or tribe 
 28.14  as a result of the change in this section must be used to 
 28.15  provide expanded mental health services as defined in sections 
 28.16  245.461 to 245.4888, the Comprehensive Adult and Children's 
 28.17  Mental Health Acts, excluding inpatient and residential 
 28.18  treatment.  For adults, increased revenue may also be used for 
 28.19  services and consumer supports which are part of adult mental 
 28.20  health projects approved under Laws 1997, chapter 203, article 
 28.21  7, section 25.  For children, increased revenue may also be used 
 28.22  for respite care and nonresidential individualized 
 28.23  rehabilitation services as defined in section 245.492, 
 28.24  subdivisions 17 and 23.  "Increased revenue" has the meaning 
 28.25  given in Minnesota Rules, part 9520.0903, subpart 3.  
 28.26     (i) (j) Notwithstanding section 256B.19, subdivision 1, the 
 28.27  nonfederal share of costs for mental health case management 
 28.28  shall be provided by the recipient's county of responsibility, 
 28.29  as defined in sections 256G.01 to 256G.12, from sources other 
 28.30  than federal funds or funds used to match other federal 
 28.31  funds.  If the service is provided by a tribal agency, the 
 28.32  nonfederal share, if any, shall be provided by the recipient's 
 28.33  tribe.  
 28.34     (j) (k) The commissioner may suspend, reduce, or terminate 
 28.35  the reimbursement to a provider that does not meet the reporting 
 28.36  or other requirements of this section.  The county of 
 29.1   responsibility, as defined in sections 256G.01 to 256G.12, or, 
 29.2   if applicable, the tribal agency, is responsible for any federal 
 29.3   disallowances.  The county or tribe may share this 
 29.4   responsibility with its contracted vendors.  
 29.5      (k) (l) The commissioner shall set aside a portion of the 
 29.6   federal funds earned under this section to repay the special 
 29.7   revenue maximization account under section 256.01, subdivision 
 29.8   2, clause (15).  The repayment is limited to: 
 29.9      (1) the costs of developing and implementing this section; 
 29.10  and 
 29.11     (2) programming the information systems. 
 29.12     (l) (m) Notwithstanding section 256.025, subdivision 2, 
 29.13  payments to counties and tribal agencies for case management 
 29.14  expenditures under this section shall only be made from federal 
 29.15  earnings from services provided under this section.  Payments to 
 29.16  contracted county-contracted vendors shall include both the 
 29.17  federal earnings and the county share. 
 29.18     (m) (n) Notwithstanding section 256B.041, county payments 
 29.19  for the cost of mental health case management services provided 
 29.20  by county or state staff shall not be made to the state 
 29.21  treasurer.  For the purposes of mental health case management 
 29.22  services provided by county or state staff under this section, 
 29.23  the centralized disbursement of payments to counties under 
 29.24  section 256B.041 consists only of federal earnings from services 
 29.25  provided under this section. 
 29.26     (n) (o) Case management services under this subdivision do 
 29.27  not include therapy, treatment, legal, or outreach services. 
 29.28     (o) (p) If the recipient is a resident of a nursing 
 29.29  facility, intermediate care facility, or hospital, and the 
 29.30  recipient's institutional care is paid by medical assistance, 
 29.31  payment for case management services under this subdivision is 
 29.32  limited to the last 30 days of the recipient's residency in that 
 29.33  facility and may not exceed more than two months in a calendar 
 29.34  year. 
 29.35     (p) (q) Payment for case management services under this 
 29.36  subdivision shall not duplicate payments made under other 
 30.1   program authorities for the same purpose. 
 30.2      (q) (r) By July 1, 2000, the commissioner shall evaluate 
 30.3   the effectiveness of the changes required by this section, 
 30.4   including changes in number of persons receiving mental health 
 30.5   case management, changes in hours of service per person, and 
 30.6   changes in caseload size. 
 30.7      (r) (s) For each calendar year beginning with the calendar 
 30.8   year 2001, the annualized amount of state funds for each county 
 30.9   determined under paragraph (g) (h) shall be adjusted by the 
 30.10  county's percentage change in the average number of clients per 
 30.11  month who received case management under this section during the 
 30.12  fiscal year that ended six months prior to the calendar year in 
 30.13  question, in comparison to the prior fiscal year. 
 30.14     (s) (t) For counties receiving the minimum allocation of 
 30.15  $3,000 or $5,000 described in paragraph (g) (h), the adjustment 
 30.16  in paragraph (r) (s) shall be determined so that the county 
 30.17  receives the higher of the following amounts: 
 30.18     (1) a continuation of the minimum allocation in paragraph 
 30.19  (g) (h); or 
 30.20     (2) an amount based on that county's average number of 
 30.21  clients per month who received case management under this 
 30.22  section during the fiscal year that ended six months prior to 
 30.23  the calendar year in question, in comparison to the prior fiscal 
 30.24  year, times the average statewide grant per person per month for 
 30.25  counties not receiving the minimum allocation. 
 30.26     (t) (u) The adjustments in paragraphs (r) and (s) and (t) 
 30.27  shall be calculated separately for children and adults. 
 30.28     Sec. 7.  Minnesota Statutes 2000, section 256B.0625, is 
 30.29  amended by adding a subdivision to read: 
 30.30     Subd. 45.  [APPEAL PROCESS.] If a county contract or 
 30.31  certification is required to enroll as an authorized provider of 
 30.32  mental health services under medical assistance, and if a county 
 30.33  refuses to grant the necessary contract or certification, the 
 30.34  provider may appeal the county decision to the commissioner.  
 30.35  The commissioner shall determine whether the provider meets 
 30.36  applicable standards under state laws and rules based on an 
 31.1   independent review of the facts, including comments from the 
 31.2   county review.  If the commissioner finds that the provider 
 31.3   meets the applicable standards, the commissioner shall enroll 
 31.4   the provider as an authorized provider. 
 31.5      Sec. 8.  Minnesota Statutes 2000, section 256B.0625, is 
 31.6   amended by adding a subdivision to read: 
 31.7      Subd. 46.  [MENTAL HEALTH PROVIDER TRAVEL TIME.] Medical 
 31.8   assistance covers provider travel time if a recipient's 
 31.9   individual treatment plan requires the provision of mental 
 31.10  health services outside of the provider's normal place of 
 31.11  business.  This does not include any travel time which is 
 31.12  included in other billable services, and is only covered when 
 31.13  the mental health service being provided to a recipient is 
 31.14  covered under medical assistance. 
 31.15     Sec. 9.  [256B.82] [PREPAID PLANS AND MENTAL HEALTH 
 31.16  REHABILITATIVE SERVICES.] 
 31.17     Medical assistance and MinnesotaCare prepaid health plans 
 31.18  may include coverage for adult mental health rehabilitative 
 31.19  services under section 256B.0623 and adult mental health crisis 
 31.20  response services under section 256B.0624, beginning January 1, 
 31.21  2004. 
 31.22     By January 15, 2003, the commissioner shall report to the 
 31.23  legislature how these services should be included in prepaid 
 31.24  plans.  The commissioner shall consult with mental health 
 31.25  advocates, health plans, and counties in developing this 
 31.26  report.  The report recommendations must include a plan to 
 31.27  ensure coordination of these services between health plans and 
 31.28  counties, assure recipient access to essential community 
 31.29  providers, and monitor the health plans' delivery of services 
 31.30  through utilization review and quality standards. 
 31.31     Sec. 10.  [256B.83] [MAINTENANCE OF EFFORT FOR CERTAIN 
 31.32  MENTAL HEALTH SERVICES.] 
 31.33     Any net increase in revenue to the county as a result of 
 31.34  the change in section 256B.0623 or 256B.0624 must be used to 
 31.35  provide expanded mental health services as defined in sections 
 31.36  245.461 to 245.486, the Comprehensive Adult Mental Health Act, 
 32.1   excluding inpatient and residential treatment.  Increased 
 32.2   revenue may also be used for services and consumer supports, 
 32.3   which are part of adult mental health projects approved under 
 32.4   section 245.4661.  "Increased revenue" has the meaning given in 
 32.5   Minnesota Rules, part 9520.0903, subpart 3. 
 32.6      Sec. 11.  [STUDY OF CHILDREN'S MENTAL HEALTH SYSTEM.] 
 32.7      The commissioner of human services shall conduct a 
 32.8   comprehensive study of the children's mental health system, 
 32.9   including, but not limited to, governance, funding for services, 
 32.10  family involvement in the provision of services, the involvement 
 32.11  of schools and other entities in the provision of services, and 
 32.12  the use of a public health model for early intervention and 
 32.13  treatment services.  This study shall be conducted in 
 32.14  consultation with the commissioner of health; the commissioner 
 32.15  of children, families, and learning; the providers of mental 
 32.16  health services in schools; other providers of mental health 
 32.17  services; parents of children receiving mental health services; 
 32.18  local children's mental health collaboratives; counties; and 
 32.19  other interested parties.  The study shall include an assessment 
 32.20  and evaluation of the family services collaboratives and mental 
 32.21  health collaboratives.  The commissioner shall report findings 
 32.22  and recommendations for changes to the children's mental health 
 32.23  system to the legislature by January 15, 2002.