Certified community behavioral health clinic rates and rebasing schedules modified.

A bill for an act

relating to medical assistance; modifying certified community behavioral health

clinic rates and rebasing schedules; amending Minnesota Statutes 2025 Supplement,

section 256B.0625, subdivision 5m.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2025 Supplement, section 256B.0625, subdivision 5m, is

amended to read:

Subd. 5m.

Certified community behavioral health clinic services.

(a) Medical

assistance covers services provided by a not-for-profit certified community behavioral health

clinic (CCBHC) that meets the requirements of section
245.735, subdivision 3
.

(b) The commissioner shall reimburse CCBHCs on a per-day basis for each day that an

eligible service is delivered using the CCBHC daily bundled rate system for medical

assistance payments as described in paragraph (c). The commissioner shall include a quality

incentive payment in the CCBHC daily bundled rate system as described in paragraph (e).

There is no county share for medical assistance services when reimbursed through the

CCBHC daily bundled rate system.

(c) The commissioner shall ensure that the CCBHC daily bundled rate system for CCBHC

payments under medical assistance meets the following requirements:

(1) the CCBHC daily bundled rate shall be a provider-specific rate calculated for each

CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable

CCBHC costs divided by the total annual number of CCBHC visits. For calculating the

payment rate, total annual visits include visits covered by medical assistance and visits not

covered by medical assistance. Allowable costs include but are not limited to the salaries

and benefits of medical assistance providers; the cost of CCBHC services provided under

section
245.735, subdivision 3
, paragraph (a), clauses (6) and (7); and other costs such as

insurance or supplies needed to provide CCBHC services;

(2) payment shall be limited to one payment per day per medical assistance enrollee

when an eligible CCBHC service is provided. A CCBHC visit is eligible for reimbursement

if at least one of the CCBHC services listed under section
245.735, subdivision 3
, paragraph

(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or

licensed agency employed by or under contract with a CCBHC;

(3) initial CCBHC daily bundled rates for newly certified CCBHCs under section
245.735,

subdivision 3
, shall be established by the commissioner using a provider-specific rate based

on the newly certified CCBHC's audited historical cost report data adjusted for the expected

cost of delivering CCBHC services. Estimates are subject to review by the commissioner

and must include the expected cost of providing the full scope of CCBHC services and the

expected number of visits for the rate period;

(4) the commissioner shall rebase CCBHC rates once every two years following the last

rebasing and no less than 12 months following an initial rate or a rate change due to a change

in the scope of services. For CCBHCs certified after September 30, 2020, and before January

1, 2021, the commissioner shall rebase rates according to this clause for services provided

on or after January 1, 2024
new text begin
. For CCBHCs certified after .... and before ...., notwithstanding

the requirement to rebase rates once every two years following the last rebasing, the

commissioner shall:
new text end

new text begin

(i) apply the rate for services provided for calendar year 2023, updated in accordance

with clause (8), for services provided through December 31, 2026; and

new text end

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(ii) rebase rates according to this clause for services provided on or after January 1,

2027
new text end
;

(5) the commissioner shall provide for a 60-day appeals process after notice of the results

of the rebasing;

(6) an entity that receives a CCBHC daily bundled rate that overlaps with another federal

Medicaid rate is not eligible for the CCBHC rate methodology;

(7) payments for CCBHC services to individuals enrolled in managed care shall be

coordinated with the state's phase-out of CCBHC wrap payments. The commissioner shall

complete the phase-out of CCBHC wrap payments within 60 days of the implementation

of the CCBHC daily bundled rate system in the Medicaid Management Information System

(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments

due made payable to CCBHCs no later than 18 months thereafter;

(8) the CCBHC daily bundled rate for each CCBHC shall be updated by trending each

provider-specific rate by the Medicare Economic Index for primary care services. This

update shall occur each year in between rebasing periods determined by the commissioner

in accordance with clause (4). CCBHCs must provide data on costs and visits to the state

annually using the CCBHC cost report established by the commissioner; and

(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of

services when such changes are expected to result in an adjustment to the CCBHC payment

rate by 2.5 percent or more. The CCBHC must provide the commissioner with information

regarding the changes in the scope of services, including the estimated cost of providing

the new or modified services and any projected increase or decrease in the number of visits

resulting from the change. Estimated costs are subject to review by the commissioner. Rate

adjustments for changes in scope shall occur no more than once per year in between rebasing

periods per CCBHC and are effective on the date of the annual CCBHC rate update.

(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC

providers at the CCBHC daily bundled rate. The commissioner shall monitor the effect of

this requirement on the rate of access to the services delivered by CCBHC providers. If, for

any contract year, federal approval is not received for this paragraph, the commissioner

must adjust the capitation rates paid to managed care plans and county-based purchasing

plans for that contract year to reflect the removal of this
deleted text begin
provision
deleted text end
new text begin
paragraph
new text end
. Contracts

between managed care plans and county-based purchasing plans and providers to whom

this paragraph applies must allow recovery of payments from those providers if capitation

rates are adjusted in accordance with this paragraph. Payment recoveries must not exceed

the amount equal to any increase in rates that results from this
deleted text begin
provision
deleted text end
new text begin
paragraph
new text end
. This

paragraph expires if federal approval is not received for this paragraph at any time.

(e) The commissioner shall implement a quality incentive payment program for CCBHCs

that meets the following requirements:

(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric

thresholds for performance metrics established by the commissioner, in addition to payments

for which the CCBHC is eligible under the CCBHC daily bundled rate system described in

paragraph (c);

(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement

year to be eligible for incentive payments;

(3) each CCBHC shall receive written notice of the criteria that must be met in order to

receive quality incentive payments at least 90 days prior to the measurement year; and

(4) a CCBHC must provide the commissioner with data needed to determine incentive

payment eligibility within six months following the measurement year. The commissioner

shall notify CCBHC providers of their performance on the required measures and the

incentive payment amount within 12 months following the measurement year.

(f) All claims to managed care plans for CCBHC services as provided under this section

shall be submitted directly to, and paid by, the commissioner on the dates specified no later

than January 1 of the following calendar year, if:

(1) one or more managed care plans does not comply with the federal requirement for

payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,

section 447.45(b), and the managed care plan does not resolve the payment issue within 30

days of noncompliance; and

(2) the total amount of clean claims not paid in accordance with federal requirements

by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims

eligible for payment by managed care plans.

If the conditions in this paragraph are met between January 1 and June 30 of a calendar

year, claims shall be submitted to and paid by the commissioner beginning on January 1 of

the following year. If the conditions in this paragraph are met between July 1 and December

31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning

on July 1 of the following year.

(g) Peer services provided by a CCBHC certified under section
245.735
are a covered

service under medical assistance when a licensed mental health professional or alcohol and

drug counselor determines that peer services are medically necessary. Eligibility under this

subdivision for peer services provided by a CCBHC supersede eligibility standards under

sections
256B.0615
,
256B.0616
, and
245G.07, subdivision 2a
, paragraph (b), clause (2).