1.1 A bill for an act
1.2 relating to behavioral health; establishing mental health case management and
1.3 community support services for persons with a complex post-traumatic stress
1.4 disorder;amending Minnesota Statutes 2024, sections 245.462, subdivision 20;
1.5 245.467, subdivision 4; 245.4711, subdivisions 1, 4; 245.4712, subdivisions 1, 3;
1.6 256B.0625, subdivision 20.
1.7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2024, section 245.462, subdivision 20, is amended to read:
1.9 Subd. 20.Mental illness. (a) "Mental illness" means an organic disorder of the brain or
1.10 a clinically significant disorder of thought, mood, perception, orientation, memory, or
1.11 behavior that is detailed in a diagnostic codes list published by the commissioner, and that
1.12 seriously limits a person's capacity to function in primary aspects of daily living such as
1.13 personal relations, living arrangements, work, and recreation.
1.14 (b) An "adult with acute mental illness" means an adult who has a mental illness that is
1.15 serious enough to require prompt intervention.
1.16 (c) For purposes of case management and community support services, a "person with
1.17 serious and persistent mental illness" means an adult who has a mental illness and meets at
1.18 least one of the following criteria:
1.19 (1) the adult has undergone two or more episodes of inpatient care for a mental illness
1.20 within the preceding 24 months;
1.21 (2) the adult has experienced a continuous psychiatric hospitalization or residential
1.22 treatment exceeding six months' duration within the preceding 12 months;
2.1 (3) the adult has been treated by a crisis team two or more times within the preceding
2.2 24 months;
2.3 (4) the adult:
2.4 (i) has a diagnosis of schizophrenia, bipolar disorder, major depression, schizoaffective
2.5 disorder, or borderline personality disorder;
2.6 (ii) indicates a significant impairment in functioning; and
2.7 (iii) has a written opinion from a mental health professional, in the last three years,
2.8 stating that the adult is reasonably likely to have future episodes requiring inpatient or
2.9 residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
2.10 management or community support services are provided;
2.11 (5) the adult has, in the last three years, been committed by a court as a person who is
2.12 mentally ill under chapter 253B, or the adult's commitment has been stayed or continued;
2.13 (6) the adult (i) was eligible under clauses (1) to (5), but the specified time period has
2.14 expired or the adult was eligible as a child under section 245.4871, subdivision 6; and (ii)
2.15 has a written opinion from a mental health professional, in the last three years, stating that
2.16 the adult is reasonably likely to have future episodes requiring inpatient or residential
2.17 treatment, of a frequency described in clause (1) or (2), unless ongoing case management
2.18 or community support services are provided; or
2.19 (7) the adult was eligible as a child under section 245.4871, subdivision 6, and is age
2.20 21 or younger.
2.21 (d) For purposes of case management and community support services, a person with
2.22 "a complex post-traumatic stress disorder" or "C-PTSD" means an adult who has a mental
2.23 illness and meets the following criteria:
2.24 (1) the adult has PTSD symptoms that significantly interfere with daily functioning
2.25 related to intergenerational trauma, racial trauma, or unresolved historical grief; and
2.26 (2) the adult has a written opinion from a mental health professional that includes
2.27 documentation of:
2.28 (i) culturally sensitive assessments or screenings and identification of intergenerational,
2.29 racial, or historical trauma;
2.30 (ii) significant impairment in functioning due to the PTSD symptoms that meet C-PTSD
2.31 condition eligibility; and
3.1 (iii) increasing concerns within the last three years to indicate that the adult is at a
3.2 reasonable likelihood of experiencing significant episodes of PTSD with increased frequency,
3.3 impacting daily functioning unless mitigated by targeted case management or community
3.4 support services.
3.5 EFFECTIVE DATE. This section is effective upon federal approval. The commissioner
3.6 of human services shall notify the revisor of statutes when federal approval is obtained.
3.7 Sec. 2. Minnesota Statutes 2024, section 245.467, subdivision 4, is amended to read:
3.8 Subd. 4.Referral for case management. Each provider of emergency services, day
3.9 treatment services, outpatient treatment, community support services, residential treatment,
3.10 acute care hospital inpatient treatment, or regional treatment center inpatient treatment must
3.11 inform each of its clients with serious and persistent mental illness or a complex
3.12 post-traumatic stress disorder of the availability and potential benefits to the client of case
3.13 management. If the client consents, the provider must refer the client by notifying the county
3.14 employee designated by the county board to coordinate case management activities of the
3.15 client's name and address and by informing the client of whom to contact to request case
3.16 management. The provider must document compliance with this subdivision in the client's
3.17 record.
3.18 EFFECTIVE DATE. This section is effective upon federal approval. The commissioner
3.19 of human services shall notify the revisor of statutes when federal approval is obtained.
3.20 Sec. 3. Minnesota Statutes 2024, section 245.4711, subdivision 1, is amended to read:
3.21 Subdivision 1.Availability of case management services. (a) By January 1, 1989, The
3.22 county board shall provide case management services for all adults with serious and persistent
3.23 mental illness or a complex post-traumatic stress disorder who are residents of the county
3.24 and who request or consent to the services and to each adult for whom the court appoints a
3.25 case manager. Staffing ratios must be sufficient to serve the needs of the clients. The case
3.26 manager must meet the requirements in section 245.462, subdivision 4.
3.27 (b) Case management services provided to adults with serious and persistent mental
3.28 illness or a complex post-traumatic stress disorder eligible for medical assistance must be
3.29 billed to the medical assistance program under sections 256B.02, subdivision 8, and
3.30 256B.0625.
3.31 (c) Case management services are eligible for reimbursement under the medical assistance
3.32 program. Costs associated with mentoring, supervision, and continuing education may be
4.1 included in the reimbursement rate methodology used for case management services under
4.2 the medical assistance program.
4.3 EFFECTIVE DATE. This section is effective upon federal approval. The commissioner
4.4 of human services shall notify the revisor of statutes when federal approval is obtained.
4.5 Sec. 4. Minnesota Statutes 2024, section 245.4711, subdivision 4, is amended to read:
4.6 Subd. 4.Individual community support plan. (a) The case manager must develop an
4.7 individual community support plan for each adult that incorporates the client's individual
4.8 treatment plan. The individual treatment plan may not be a substitute for the development
4.9 of an individual community support plan. The individual community support plan must be
4.10 developed within 30 days of client intake and reviewed at least every 180 days after it is
4.11 developed, unless the case manager receives a written request from the client or the client's
4.12 family for a review of the plan every 90 days after it is developed. The case manager is
4.13 responsible for developing the individual community support plan based on a diagnostic
4.14 assessment and a functional assessment and for implementing and monitoring the delivery
4.15 of services according to the individual community support plan. To the extent possible, the
4.16 adult with serious and persistent mental illness or a complex post-traumatic stress disorder,
4.17 the person's family, advocates, service providers, and significant others must be involved
4.18 in all phases of development and implementation of the individual community support plan.
4.19 (b) The client's individual community support plan must state:
4.20 (1) the goals of each service;
4.21 (2) the activities for accomplishing each goal;
4.22 (3) a schedule for each activity; and
4.23 (4) the frequency of face-to-face contacts by the case manager, as appropriate to client
4.24 need and the implementation of the individual community support plan.
4.25 EFFECTIVE DATE. This section is effective upon federal approval. The commissioner
4.26 of human services shall notify the revisor of statutes when federal approval is obtained.
4.27 Sec. 5. Minnesota Statutes 2024, section 245.4712, subdivision 1, is amended to read:
4.28 Subdivision 1.Availability of community support services. (a) County boards must
4.29 provide or contract for sufficient community support services within the county to meet the
4.30 needs of adults with serious and persistent mental illness or a complex post-traumatic stress
4.31 disorder who are residents of the county. Adults may be required to pay a fee according to
5.1 section 245.481. The community support services program must be designed to improve
5.2 the ability of adults with serious and persistent mental illness or a complex post-traumatic
5.3 stress disorder to:
5.4 (1) find and maintain competitive employment;
5.5 (2) handle basic activities of daily living;
5.6 (3) participate in leisure time activities;
5.7 (4) set goals and plans; and
5.8 (5) obtain and maintain appropriate living arrangements.
5.9 The community support services program must also be designed to reduce the need for
5.10 and use of more intensive, costly, or restrictive placements both in number of admissions
5.11 and length of stay.
5.12 (b) Community support services are those services that are supportive in nature and not
5.13 necessarily treatment oriented, and include:
5.14 (1) conducting outreach activities such as home visits, health and wellness checks, and
5.15 problem solving;
5.16 (2) connecting people to resources to meet their basic needs;
5.17 (3) finding, securing, and supporting people in their housing;
5.18 (4) attaining and maintaining health insurance benefits;
5.19 (5) assisting with job applications, finding and maintaining employment, and securing
5.20 a stable financial situation;
5.21 (6) fostering social support, including support groups, mentoring, peer support, and other
5.22 efforts to prevent isolation and promote recovery; and
5.23 (7) educating about mental illness, treatment, and recovery.
5.24 (c) Community support services shall use all available funding streams. The county shall
5.25 maintain the level of expenditures for this program, as required under section 245.4835.
5.26 County boards must continue to provide funds for those services not covered by other
5.27 funding streams and to maintain an infrastructure to carry out these services. The county is
5.28 encouraged to fund evidence-based practices such as Individual Placement and Supported
5.29 Employment and Illness Management and Recovery.
5.30 (d) The commissioner shall collect data on community support services programs,
5.31 including, but not limited to, demographic information such as age, sex, race, the number
6.1 of people served, and information related to housing, employment, hospitalization, symptoms,
6.2 and satisfaction with services.
6.3 EFFECTIVE DATE. This section is effective upon federal approval. The commissioner
6.4 of human services shall notify the revisor of statutes when federal approval is obtained.
6.5 Sec. 6. Minnesota Statutes 2024, section 245.4712, subdivision 3, is amended to read:
6.6 Subd. 3.Benefits assistance. The county board must offer to help adults with serious
6.7 and persistent mental illness or a complex post-traumatic stress disorder in applying for
6.8 state and federal benefits, including Supplemental Security Income, medical assistance,
6.9 Medicare, general assistance, and Minnesota supplemental aid. The help must be offered
6.10 as part of the community support program available to adults with serious and persistent
6.11 mental illness or a complex post-traumatic stress disorder for whom the county is financially
6.12 responsible and who may qualify for these benefits.
6.13 Sec. 7. Minnesota Statutes 2024, section 256B.0625, subdivision 20, is amended to read:
6.14 Subd. 20.Mental health case management. (a) To the extent authorized by rule of the
6.15 state agency, medical assistance covers case management services to persons with serious
6.16 and persistent mental illness, persons with a complex post-traumatic stress disorder, and
6.17 children with severe emotional disturbance. Services provided under this section must meet
6.18 the relevant standards in sections 245.461 to 245.4887, the Comprehensive Adult and
6.19 Children's Mental Health Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and
6.20 9505.0322, excluding subpart 10.
6.21 (b) Entities meeting program standards set out in rules governing family community
6.22 support services as defined in section 245.4871, subdivision 17, are eligible for medical
6.23 assistance reimbursement for case management services for children with severe emotional
6.24 disturbance when these services meet the program standards in Minnesota Rules, parts
6.25 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
6.26 (c) Medical assistance and MinnesotaCare payment for mental health case management
6.27 shall be made on a monthly basis. In order to receive payment for an eligible child, the
6.28 provider must document at least a face-to-face contact either in person or by interactive
6.29 video that meets the requirements of subdivision 20b with the child, the child's parents, or
6.30 the child's legal representative. To receive payment for an eligible adult, the provider must
6.31 document:
7.1 (1) at least a face-to-face contact with the adult or the adult's legal representative either
7.2 in person or by interactive video that meets the requirements of subdivision 20b; or
7.3 (2) at least a telephone contact with the adult or the adult's legal representative and
7.4 document a face-to-face contact either in person or by interactive video that meets the
7.5 requirements of subdivision 20b with the adult or the adult's legal representative within the
7.6 preceding two months.
7.7 (d) Payment for mental health case management provided by county or state staff shall
7.8 be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
7.9 (b), with separate rates calculated for child welfare and mental health, and within mental
7.10 health, separate rates for children and adults.
7.11 (e) Payment for mental health case management provided by Indian health services or
7.12 by agencies operated by Indian tribes may be made according to this section or other relevant
7.13 federally approved rate setting methodology.
7.14 (f) Payment for mental health case management provided by vendors who contract with
7.15 a county must be calculated in accordance with section 256B.076, subdivision 2. Payment
7.16 for mental health case management provided by vendors who contract with a Tribe must
7.17 be based on a monthly rate negotiated by the Tribe. The rate must not exceed the rate charged
7.18 by the vendor for the same service to other payers. If the service is provided by a team of
7.19 contracted vendors, the team shall determine how to distribute the rate among its members.
7.20 No reimbursement received by contracted vendors shall be returned to the county or tribe,
7.21 except to reimburse the county or tribe for advance funding provided by the county or tribe
7.22 to the vendor.
7.23 (g) If the service is provided by a team which includes contracted vendors, tribal staff,
7.24 and county or state staff, the costs for county or state staff participation in the team shall be
7.25 included in the rate for county-provided services. In this case, the contracted vendor, the
7.26 tribal agency, and the county may each receive separate payment for services provided by
7.27 each entity in the same month. In order to prevent duplication of services, each entity must
7.28 document, in the recipient's file, the need for team case management and a description of
7.29 the roles of the team members.
7.30 (h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
7.31 mental health case management shall be provided by the recipient's county of responsibility,
7.32 as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
7.33 used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
7.34 share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
8.1 without a federal share through fee-for-service, 50 percent of the cost shall be provided by
8.2 the recipient's county of responsibility.
8.3 (i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
8.4 and MinnesotaCare include mental health case management. When the service is provided
8.5 through prepaid capitation, the nonfederal share is paid by the state and the county pays no
8.6 share.
8.7 (j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
8.8 that does not meet the reporting or other requirements of this section. The county of
8.9 responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
8.10 is responsible for any federal disallowances. The county or tribe may share this responsibility
8.11 with its contracted vendors.
8.12 (k) The commissioner shall set aside a portion of the federal funds earned for county
8.13 expenditures under this section to repay the special revenue maximization account under
8.14 section 256.01, subdivision 2, paragraph (n). The repayment is limited to:
8.15 (1) the costs of developing and implementing this section; and
8.16 (2) programming the information systems.
8.17 (l) Payments to counties and tribal agencies for case management expenditures under
8.18 this section shall only be made from federal earnings from services provided under this
8.19 section. When this service is paid by the state without a federal share through fee-for-service,
8.20 50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
8.21 shall include the federal earnings, the state share, and the county share.
8.22 (m) Case management services under this subdivision do not include therapy, treatment,
8.23 legal, or outreach services.
8.24 (n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
8.25 and the recipient's institutional care is paid by medical assistance, payment for case
8.26 management services under this subdivision is limited to the lesser of:
8.27 (1) the last 180 days of the recipient's residency in that facility and may not exceed more
8.28 than six months in a calendar year; or
8.29 (2) the limits and conditions which apply to federal Medicaid funding for this service.
8.30 (o) Payment for case management services under this subdivision shall not duplicate
8.31 payments made under other program authorities for the same purpose.
9.1 (p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
9.2 licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
9.3 mental health targeted case management services must actively support identification of
9.4 community alternatives for the recipient and discharge planning.
9.5 EFFECTIVE DATE. This section is effective upon federal approval. The commissioner
9.6 of human services shall notify the revisor of statutes when federal approval is obtained.
