Intensive residential treatment services and intensive nonresidential rehabilitative mental health services requirements modification

A bill for an act

relating to human services; modifying intensive residential treatment services and

intensive nonresidential rehabilitative mental health services requirements;

specifying that room and board services provided through intensive residential

treatment services and residential crisis services are eligible for behavioral health

fund payment; amending Minnesota Statutes 2024, section 256B.0947, subdivision

5; Minnesota Statutes 2025 Supplement, sections 245I.23, subdivision 7; 254B.04,

subdivision 1a.

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

Section 1.

Minnesota Statutes 2025 Supplement, section 245I.23, subdivision 7, is amended

to read:

Subd. 7.

Intensive residential treatment services assessment and treatment

planning.

(a) Within 12 hours of a client's admission, the license holder must evaluate and

document the client's immediate needs, including the client's:

(1) health and safety, including the client's need for crisis assistance;

(2) responsibilities for children, family and other natural supports, and employers; and

(3) housing and legal issues.

(b) Within 24 hours of the client's admission, the license holder must complete an initial

treatment plan for the client. The license holder must:

(1) base the client's initial treatment plan on the client's referral information and an

assessment of the client's immediate needs;

(2) consider crisis assistance strategies that have been effective for the client in the past;

(3) identify the client's initial treatment goals, measurable treatment objectives, and

specific interventions that the license holder will use to help the client engage in treatment;

(4) identify the participants involved in the client's treatment planning. The client must

be a participant; and

(5) ensure that a treatment supervisor approves of the client's initial treatment plan if a

behavioral health practitioner or clinical trainee completes the client's treatment plan,

notwithstanding section
245I.08, subdivision 3
.

(c) According to section
245A.65, subdivision 2
, paragraph (b), the license holder must

complete an individual abuse prevention plan as part of a client's initial treatment plan.

(d) Within five days of the client's admission and again within 60 days after the client's

admission, the license holder must complete a level of care assessment of the client. If the

license holder determines that a client does not need a medically monitored level of service,

a treatment supervisor must document how the client's admission to and continued services

in intensive residential treatment services are medically necessary for the client.

(e) Within ten days of a client's admission,
new text begin
excluding weekends and holidays,
new text end
the license

holder must complete or review and update the client's standard diagnostic assessment.

(f) Within ten days of a client's admission, the license holder must complete the client's

individual treatment plan, notwithstanding section
245I.10, subdivision 8
. Within 40 days

after the client's admission and again within 70 days after the client's admission, the license

holder must update the client's individual treatment plan. The license holder must focus the

client's treatment planning on preparing the client for a successful transition from intensive

residential treatment services to another setting. In addition to the required elements of an

individual treatment plan under section
245I.10, subdivision 8
, the license holder must

identify the following information in the client's individual treatment plan: (1) the client's

referrals and resources for the client's health and safety; and (2) the staff persons who are

responsible for following up with the client's referrals and resources. If the client does not

receive a referral or resource that the client needs, the license holder must document the

reason that the license holder did not make the referral or did not connect the client to a

particular resource. The license holder is responsible for determining whether additional

follow-up is required on behalf of the client.

(g) Within 30 days of the client's admission, the license holder must complete a functional

assessment of the client. Within 60 days after the client's admission, the license holder must

update the client's functional assessment to include any changes in the client's functioning

and symptoms.

(h) For a client with a current substance use disorder diagnosis and for a client whose

substance use disorder screening in the client's standard diagnostic assessment indicates the

possibility that the client has a substance use disorder, the license holder must complete a

written assessment of the client's substance use within 30 days of the client's admission. In

the substance use assessment, the license holder must: (1) evaluate the client's history of

substance use, relapses, and hospitalizations related to substance use; (2) assess the effects

of the client's substance use on the client's relationships including with family member and

others; (3) identify financial problems, health issues, housing instability, and unemployment;

(4) assess the client's legal problems, past and pending incarceration, violence, and

victimization; and (5) evaluate the client's suicide attempts, noncompliance with taking

prescribed medications, and noncompliance with psychosocial treatment.

(i) On a weekly basis, a mental health professional or certified rehabilitation specialist

must review each client's treatment plan and individual abuse prevention plan. The license

holder must document in the client's file each weekly review of the client's treatment plan

and individual abuse prevention plan.

Sec. 2.

Minnesota Statutes 2025 Supplement, section 254B.04, subdivision 1a, is amended

to read:

Subd. 1a.

Client eligibility.

(a) Persons eligible for benefits under Code of Federal

Regulations, title 25, part 20, who meet the income standards of section
256B.056,

subdivision 4
, and are not enrolled in medical assistance, are entitled to behavioral health

fund services. State money appropriated for this paragraph must be placed in a separate

account established for this purpose.

(b) Persons with dependent children who are determined to be in need of substance use

disorder treatment pursuant to an assessment under section
260E.20, subdivision 1
, or in

need of chemical dependency treatment pursuant to a case plan under section
260C.201,

subdivision 6
, or
260C.212
, shall be assisted by the commissioner to access needed treatment

services. Treatment services must be appropriate for the individual or family, which may

include long-term care treatment or treatment in a facility that allows the dependent children

to stay in the treatment facility. The county shall pay for out-of-home placement costs, if

applicable.

(c) Notwithstanding paragraph (a), any person enrolled in medical assistance or

MinnesotaCare is eligible for room and board services under section
254B.0505, subdivision

1
, clause (9).

(d) A client is eligible to have substance use disorder treatment paid for with funds from

the behavioral health fund when the client:

(1) is eligible for MFIP as determined under chapter 142G;

(2) is eligible for medical assistance as determined under Minnesota Rules, parts

9505.0010
to
9505.0140
;

(3) is eligible for general assistance, general assistance medical care, or work readiness

as determined under Minnesota Rules, parts
9500.1200
to
9500.1272
; or

(4) has income that is within current household size and income guidelines for entitled

persons, as defined in this subdivision and subdivision 7.

(e) Clients who meet the financial eligibility requirement in paragraph (a) and who have

a third-party payment source are eligible for the behavioral health fund if the third-party

payment source pays less than 100 percent of the cost of treatment services for eligible

clients.

(f) A client is ineligible to have substance use disorder treatment services paid for with

behavioral health fund money if the client:

(1) has an income that exceeds current household size and income guidelines for entitled

persons as defined in this subdivision and subdivision 7; or

(2) has an available third-party payment source that will pay the total cost of the client's

treatment.

(g) A client who is disenrolled from a state prepaid health plan during a treatment episode

is eligible for continued treatment service that is paid for by the behavioral health fund until

the treatment episode is completed or the client is re-enrolled in a state prepaid health plan

if the client:

(1) continues to be enrolled in MinnesotaCare, medical assistance, or general assistance

medical care; or

(2) is eligible according to paragraphs (a) and (b) and is determined eligible by the

commissioner under section
254B.04
.

(h) When a county commits a client under chapter 253B to a regional treatment center

for substance use disorder services and the client is ineligible for the behavioral health fund,

the county is responsible for the payment to the regional treatment center according to

section
254B.0501, subdivision 3
.

(i)
new text begin
Notwithstanding any laws to the contrary,
new text end
persons enrolled in MinnesotaCare
new text begin
or

medical assistance
new text end
are eligible for room and board services when provided through intensive

residential treatment services and residential crisis services under section
256B.0632
new text begin
and

chapter 245I
new text end
.

(j) A person is eligible for one 60-consecutive-calendar-day period per year. A person

may submit a request for additional eligibility to the commissioner. A person denied

additional eligibility under this paragraph may request a state agency hearing under section

256.045
.

Sec. 3.

Minnesota Statutes 2024, section 256B.0947, subdivision 5, is amended to read:

Subd. 5.

Standards for intensive nonresidential rehabilitative providers.

(a) Services

must meet the standards in this section and chapter 245I as required in section
245I.011,

subdivision 5
.

(b) The treatment team must have specialized training in providing services to the specific

age group of youth that the team serves. An individual treatment team must serve youth

who are: (1) at least eight years of age or older and under 16 years of age, or (2) at least 14

years of age or older and under 21 years of age.

(c) The treatment team for intensive nonresidential rehabilitative mental health services

comprises both permanently employed core team members and client-specific team members

as follows:

(1) Based on professional qualifications and client needs, clinically qualified core team

members are assigned on a rotating basis as the client's lead worker to coordinate a client's

care. The core team must comprise at least four full-time equivalent direct care staff and

must minimally include:

(i) a mental health professional who serves as team leader to provide administrative

direction and treatment supervision to the team;

(ii) an advanced-practice registered nurse with certification in psychiatric or mental

health care or a board-certified
deleted text begin
child and adolescent
deleted text end
psychiatrist, either of which must be

credentialed to prescribe medications;

(iii) a mental health certified peer specialist who is qualified according to section
245I.04,

subdivision 10
, and is also a former children's mental health consumer; and

(iv) a co-occurring disorder specialist who meets the requirements under section

256B.0622, subdivision 7a
, paragraph (a), clause (4), who will provide or facilitate the

provision of co-occurring disorder treatment to clients.

(2) The core team may also include any of the following:

(i) additional mental health professionals;

(ii) a vocational specialist;

(iii) an educational specialist with knowledge and experience working with youth

regarding special education requirements and goals, special education plans, and coordination

of educational activities with health care activities;

(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;

(v) a clinical trainee qualified according to section
245I.04, subdivision 6
;

(vi) a mental health practitioner qualified according to section
245I.04, subdivision 4
;

(vii) a case management service provider, as defined in section
245.4871, subdivision

4
;

(viii) a housing access specialist;
deleted text begin
and
deleted text end

(ix) a family peer specialist as defined in subdivision 2, paragraph (j)
deleted text begin
.
deleted text end
new text begin
; and
new text end

new text begin

(x) a registered nurse, as defined in section 148.171, subdivision 20.

new text end

(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc

members not employed by the team who consult on a specific client and who must accept

overall clinical direction from the treatment team for the duration of the client's placement

with the treatment team and must be paid by the provider agency at the rate for a typical

session by that provider with that client or at a rate negotiated with the client-specific

member. Client-specific treatment team members may include:

(i) the mental health professional treating the client prior to placement with the treatment

team;

(ii) the client's current substance use counselor, if applicable;

(iii) a lead member of the client's individualized education program team or school-based

mental health provider, if applicable;

(iv) a representative from the client's health care home or primary care clinic, as needed

to ensure integration of medical and behavioral health care;

(v) the client's probation officer or other juvenile justice representative, if applicable;

and

(vi) the client's current vocational or employment counselor, if applicable.

(d) The treatment supervisor shall be an active member of the treatment team and shall

function as a practicing clinician at least on a part-time basis. The treatment team shall meet

with the treatment supervisor at least weekly to discuss recipients' progress and make rapid

adjustments to meet recipients' needs. The team meeting must include client-specific case

reviews and general treatment discussions among team members. Client-specific case

reviews and planning must be documented in the individual client's treatment record.

(e) The staffing ratio must not exceed ten clients to one full-time equivalent treatment

team position.

(f) The treatment team shall serve no more than 80 clients at any one time. Should local

demand exceed the team's capacity, an additional team must be established rather than

exceed this limit.

(g) Nonclinical staff shall have prompt access in person or by telephone to a mental

health practitioner, clinical trainee, or mental health professional. The provider shall have

the capacity to promptly and appropriately respond to emergent needs and make any

necessary staffing adjustments to ensure the health and safety of clients.

(h) The intensive nonresidential rehabilitative mental health services provider shall

participate in evaluation of the assertive community treatment for youth (Youth ACT) model

as conducted by the commissioner, including the collection and reporting of data and the

reporting of performance measures as specified by contract with the commissioner.

(i) A regional treatment team may serve multiple counties.