1.1 A bill for an act
1.2 relating to human services; modifying timelines for filing medical claims after
1.3 recoupment; modifying county of financial responsibility for withdrawal
1.4 management services; imposing closure planning requirements on providers of
1.5 peer recovery supports; modifying required timelines for mental health diagnostic
1.6 assessments; amending Minnesota Statutes 2024, sections 62Q.75, subdivision 3;
1.7 254B.05, subdivisions 1, 5; proposing coding for new law in Minnesota Statutes,
1.8 chapter 256G.
1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.10 Section 1. Minnesota Statutes 2024, section 62Q.75, subdivision 3, is amended to read:
1.11 Subd. 3.Claims filing.(a) Unless otherwise provided by contract, by section 16A.124,
1.12subdivision 4a, or by federal law, the health care providers and facilities specified in
1.13subdivision 2 must submit their charges to a health plan company or third-party administrator
1.14within six months from the date of service or the date the health care provider knew or was
1.15informed of the correct name and address of the responsible health plan company or
1.16third-party administrator, whichever is later.
1.17 (b) A health care provider or facility that does not make an initial submission of charges
1.18within the six-month period in paragraph (a), the 12-month period in paragraph (c), or the
1.19additional six-month period in paragraph (d) shall not be reimbursed for the charge and may
1.20not collect the charge from the recipient of the service or any other payer.
1.21 (c) The six-month submission requirement in paragraph (a) may be extended to 12
1.22months in cases where a health care provider or facility specified in subdivision 2 has
1.23determined and can substantiate that it has experienced a significant disruption to normal
1.24operations that materially affects the ability to conduct business in a normal manner and to
1.25submit claims on a timely basis.
1Section 1.
REVISOR DTT/HL 25-0274602/21/25
State of Minnesota
This Document can be made available
in alternative formats upon request
HOUSE OF REPRESENTATIVES
H. F. No. 1963
NINETY-FOURTH SESSION
Authored by Frederick, Hicks and Virnig03/06/2025
The bill was read for the first time and referred to the Committee on Human Services Finance and Policy 2.1 (d) The six-month submission requirement in paragraph (a) may be extended an additional
2.2six months if a health plan company or third-party administrator makes any adjustment or
2.3recoupment of payment. The additional six months begins on the date the health plan
2.4company or third-party administrator adjusts or recoups the payment.
2.5 (e) Any request by a health care provider or facility specified in subdivision 2 for an
2.6exception to a contractually defined claims submission timeline must be reviewed and acted
2.7upon by the health plan company within the same time frame as the contractually agreed
2.8upon claims filing timeline.
2.9 (f) This subdivision also applies to all health care providers and facilities that submit
2.10charges to workers' compensation payers for treatment of a workers' compensation injury
2.11compensable under chapter 176, or to reparation obligors for treatment of an injury
2.12compensable under chapter 65B.
2.13 Sec. 2. Minnesota Statutes 2024, section 254B.05, subdivision 1, is amended to read:
2.14 Subdivision 1.Licensure or certification required.(a) Programs licensed by the
2.15commissioner are eligible vendors. Hospitals may apply for and receive licenses to be
2.16eligible vendors, notwithstanding the provisions of section 245A.03. American Indian
2.17programs that provide substance use disorder treatment, extended care, transitional residence,
2.18or outpatient treatment services, and are licensed by tribal government are eligible vendors.
2.19 (b) A licensed professional in private practice as defined in section 245G.01, subdivision
2.2017, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible
2.21vendor of a comprehensive assessment provided according to section 254A.19, subdivision
2.223, and treatment services provided according to sections 245G.06 and 245G.07, subdivision
2.231, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses (1) to (6).
2.24 (c) A county is an eligible vendor for a comprehensive assessment when provided by
2.25an individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 5,
2.26and completed according to the requirements of section 254A.19, subdivision 3. A county
2.27is an eligible vendor of care coordination services when provided by an individual who
2.28meets the staffing credentials of section 245G.11, subdivisions 1 and 7, and provided
2.29according to the requirements of section 245G.07, subdivision 1, paragraph (a), clause (5).
2.30A county is an eligible vendor of peer recovery services when the services are provided by
2.31an individual who meets the requirements of section 245G.11, subdivision 8.
2.32 (d) A recovery community organization that meets the requirements of clauses (1) to
2.33(14) and meets certification or accreditation requirements of the Alliance for Recovery
2Sec. 2.
REVISOR DTT/HL 25-0274602/21/25 3.1Centered Organizations, the Council on Accreditation of Peer Recovery Support Services,
3.2or a Minnesota statewide recovery organization identified by the commissioner is an eligible
3.3vendor of peer recovery support services. A Minnesota statewide recovery organization
3.4identified by the commissioner must update recovery community organization applicants
3.5for certification or accreditation on the status of the application within 45 days of receipt.
3.6If the approved statewide recovery organization denies an application, it must provide a
3.7written explanation for the denial to the recovery community organization. Eligible vendors
3.8under this paragraph must:
3.9 (1) be nonprofit organizations under section 501(c)(3) of the Internal Revenue Code, be
3.10free from conflicting self-interests, and be autonomous in decision-making, program
3.11development, peer recovery support services provided, and advocacy efforts for the purpose
3.12of supporting the recovery community organization's mission;
3.13 (2) be led and governed by individuals in the recovery community, with more than 50
3.14percent of the board of directors or advisory board members self-identifying as people in
3.15personal recovery from substance use disorders;
3.16 (3) have a mission statement and conduct corresponding activities indicating that the
3.17organization's primary purpose is to support recovery from substance use disorder;
3.18 (4) demonstrate ongoing community engagement with the identified primary region and
3.19population served by the organization, including individuals in recovery and their families,
3.20friends, and recovery allies;
3.21 (5) be accountable to the recovery community through documented priority-setting and
3.22participatory decision-making processes that promote the engagement of, and consultation
3.23with, people in recovery and their families, friends, and recovery allies;
3.24 (6) provide nonclinical peer recovery support services, including but not limited to
3.25recovery support groups, recovery coaching, telephone recovery support, skill-building,
3.26and harm-reduction activities, and provide recovery public education and advocacy;
3.27 (7) have written policies that allow for and support opportunities for all paths toward
3.28recovery and refrain from excluding anyone based on their chosen recovery path, which
3.29may include but is not limited to harm reduction paths, faith-based paths, and nonfaith-based
3.30paths;
3.31 (8) maintain organizational practices to meet the needs of Black, Indigenous, and people
3.32of color communities, LGBTQ+ communities, and other underrepresented or marginalized
3Sec. 2.
REVISOR DTT/HL 25-0274602/21/25 4.1communities. Organizational practices may include board and staff training, service offerings,
4.2advocacy efforts, and culturally informed outreach and services;
4.3 (9) use recovery-friendly language in all media and written materials that is supportive
4.4of and promotes recovery across diverse geographical and cultural contexts and reduces
4.5stigma;
4.6 (10) establish and maintain a publicly available recovery community organization code
4.7of ethics and grievance policy and procedures;
4.8 (11) not classify or treat any recovery peer hired on or after July 1, 2024, as an
4.9independent contractor;
4.10 (12) not classify or treat any recovery peer as an independent contractor on or after
4.11January 1, 2025;
4.12 (13) provide an orientation for recovery peers that includes an overview of the consumer
4.13advocacy services provided by the Ombudsman for Mental Health and Developmental
4.14Disabilities and other relevant advocacy services; and
4.15 (14) provide notice to peer recovery support services participants that includes the
4.16following statement: "If you have a complaint about the provider or the person providing
4.17your peer recovery support services, you may contact the Minnesota Alliance of Recovery
4.18Community Organizations. You may also contact the Office of Ombudsman for Mental
4.19Health and Developmental Disabilities." The statement must also include:
4.20 (i) the telephone number, website address, email address, and mailing address of the
4.21Minnesota Alliance of Recovery Community Organizations and the Office of Ombudsman
4.22for Mental Health and Developmental Disabilities;
4.23 (ii) the recovery community organization's name, address, email, telephone number, and
4.24name or title of the person at the recovery community organization to whom problems or
4.25complaints may be directed; and
4.26 (iii) a statement that the recovery community organization will not retaliate against a
4.27peer recovery support services participant because of a complaint; and
4.28 (15) comply with the requirements of section 245A.04, subdivision 15a.
4.29 (e) A recovery community organization approved by the commissioner before June 30,
4.302023, must have begun the application process as required by an approved certifying or
4.31accrediting entity and have begun the process to meet the requirements under paragraph (d)
4Sec. 2.
REVISOR DTT/HL 25-0274602/21/25 5.1by September 1, 2024, in order to be considered as an eligible vendor of peer recovery
5.2support services.
5.3 (f) A recovery community organization that is aggrieved by an accreditation, certification,
5.4or membership determination and believes it meets the requirements under paragraph (d)
5.5may appeal the determination under section 256.045, subdivision 3, paragraph (a), clause
5.6(14), for reconsideration as an eligible vendor. If the human services judge determines that
5.7the recovery community organization meets the requirements under paragraph (d), the
5.8recovery community organization is an eligible vendor of peer recovery support services.
5.9 (g) All recovery community organizations must be certified or accredited by an entity
5.10listed in paragraph (d) by June 30, 2025.
5.11 (h) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
5.129530.6590, are not eligible vendors. Programs that are not licensed as a residential or
5.13nonresidential substance use disorder treatment or withdrawal management program by the
5.14commissioner or by tribal government or do not meet the requirements of subdivisions 1a
5.15and 1b are not eligible vendors.
5.16 (i) Hospitals, federally qualified health centers, and rural health clinics are eligible
5.17vendors of a comprehensive assessment when the comprehensive assessment is completed
5.18according to section 254A.19, subdivision 3, and by an individual who meets the criteria
5.19of an alcohol and drug counselor according to section 245G.11, subdivision 5. The alcohol
5.20and drug counselor must be individually enrolled with the commissioner and reported on
5.21the claim as the individual who provided the service.
5.22 (j) Any complaints about a recovery community organization or peer recovery support
5.23services may be made to and reviewed or investigated by the ombudsperson for behavioral
5.24health and developmental disabilities under sections 245.91 and 245.94.
5.25 Sec. 3. Minnesota Statutes 2024, section 254B.05, subdivision 5, is amended to read:
5.26 Subd. 5.Rate requirements.(a) The commissioner shall establish rates for substance
5.27use disorder services and service enhancements funded under this chapter.
5.28 (b) Eligible substance use disorder treatment services include:
5.29 (1) those licensed, as applicable, according to chapter 245G or applicable Tribal license
5.30and provided according to the following ASAM levels of care:
5.31 (i) ASAM level 0.5 early intervention services provided according to section 254B.19,
5.32subdivision 1, clause (1);
5Sec. 3.
REVISOR DTT/HL 25-0274602/21/25 6.1 (ii) ASAM level 1.0 outpatient services provided according to section 254B.19,
6.2subdivision 1, clause (2);
6.3 (iii) ASAM level 2.1 intensive outpatient services provided according to section 254B.19,
6.4subdivision 1, clause (3);
6.5 (iv) ASAM level 2.5 partial hospitalization services provided according to section
6.6254B.19, subdivision 1, clause (4);
6.7 (v) ASAM level 3.1 clinically managed low-intensity residential services provided
6.8according to section 254B.19, subdivision 1, clause (5). The commissioner shall use the
6.9base payment rate of $79.84 per day for services provided under this item;
6.10 (vi) ASAM level 3.1 clinically managed low-intensity residential services provided
6.11according to section 254B.19, subdivision 1, clause (5), at 15 or more hours of skilled
6.12treatment services each week. The commissioner shall use the base payment rate of $166.13
6.13per day for services provided under this item;
6.14 (vii) ASAM level 3.3 clinically managed population-specific high-intensity residential
6.15services provided according to section 254B.19, subdivision 1, clause (6). The commissioner
6.16shall use the specified base payment rate of $224.06 per day for services provided under
6.17this item; and
6.18 (viii) ASAM level 3.5 clinically managed high-intensity residential services provided
6.19according to section 254B.19, subdivision 1, clause (7). The commissioner shall use the
6.20specified base payment rate of $224.06 per day for services provided under this item;
6.21 (2) comprehensive assessments provided according to section 254A.19, subdivision 3;
6.22 (3) treatment coordination services provided according to section 245G.07, subdivision
6.231, paragraph (a), clause (5);
6.24 (4) peer recovery support services provided according to section 245G.07, subdivision
6.252, clause (8);
6.26 (5) withdrawal management services provided according to chapter 245F;
6.27 (6) hospital-based treatment services that are licensed according to sections 245G.01 to
6.28245G.17 or applicable Tribal license and licensed as a hospital under sections 144.50 to
6.29144.56;
6.30 (7) substance use disorder treatment services with medications for opioid use disorder
6.31provided in an opioid treatment program licensed according to sections 245G.01 to 245G.17
6.32and 245G.22, or under an applicable Tribal license;
6Sec. 3.
REVISOR DTT/HL 25-0274602/21/25 7.1 (8) medium-intensity residential treatment services that provide 15 hours of skilled
7.2treatment services each week and are licensed according to sections 245G.01 to 245G.17
7.3and 245G.21 or applicable Tribal license;
7.4 (9) adolescent treatment programs that are licensed as outpatient treatment programs
7.5according to sections 245G.01 to 245G.18 or as residential treatment programs according
7.6to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
7.7applicable Tribal license;
7.8 (10) ASAM 3.5 clinically managed high-intensity residential services that are licensed
7.9according to sections 245G.01 to 245G.17 and 245G.21 or applicable Tribal license, which
7.10provide ASAM level of care 3.5 according to section 254B.19, subdivision 1, clause (7),
7.11and are provided by a state-operated vendor or to clients who have been civilly committed
7.12to the commissioner, present the most complex and difficult care needs, and are a potential
7.13threat to the community; and
7.14 (11) room and board facilities that meet the requirements of subdivision 1a.
7.15 (c) The commissioner shall establish higher rates for programs that meet the requirements
7.16of paragraph (b) and one of the following additional requirements:
7.17 (1) programs that serve parents with their children if the program:
7.18 (i) provides on-site child care during the hours of treatment activity that:
7.19 (A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
7.209503; or
7.21 (B) is licensed under chapter 245A and sections 245G.01 to 245G.19; or
7.22 (ii) arranges for off-site child care during hours of treatment activity at a facility that is
7.23licensed under chapter 245A as:
7.24 (A) a child care center under Minnesota Rules, chapter 9503; or
7.25 (B) a family child care home under Minnesota Rules, chapter 9502;
7.26 (2) culturally specific or culturally responsive programs as defined in section 254B.01,
7.27subdivision 4a;
7.28 (3) disability responsive programs as defined in section 254B.01, subdivision 4b;
7.29 (4) programs that offer medical services delivered by appropriately credentialed health
7.30care staff in an amount equal to one hour per client per week if the medical needs of the
7Sec. 3.
REVISOR DTT/HL 25-0274602/21/25 8.1client and the nature and provision of any medical services provided are documented in the
8.2client file; or
8.3 (5) programs that offer services to individuals with co-occurring mental health and
8.4substance use disorder problems if:
8.5 (i) the program meets the co-occurring requirements in section 245G.20;
8.6 (ii) the program employs a mental health professional as defined in section 245I.04,
8.7subdivision 2;
8.8 (iii) clients scoring positive on a standardized mental health screen receive a mental
8.9health diagnostic assessment within ten days of admission, excluding weekends and holidays;
8.10 (iv) the program has standards for multidisciplinary case review that include a monthly
8.11review for each client that, at a minimum, includes a licensed mental health professional
8.12and licensed alcohol and drug counselor, and their involvement in the review is documented;
8.13 (v) family education is offered that addresses mental health and substance use disorder
8.14and the interaction between the two; and
8.15 (vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
8.16training annually.
8.17 (d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
8.18that provides arrangements for off-site child care must maintain current documentation at
8.19the substance use disorder facility of the child care provider's current licensure to provide
8.20child care services.
8.21 (e) Adolescent residential programs that meet the requirements of Minnesota Rules,
8.22parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
8.23in paragraph (c), clause (5), items (i) to (iv).
8.24 (f) Substance use disorder services that are otherwise covered as direct face-to-face
8.25services may be provided via telehealth as defined in section 256B.0625, subdivision 3b.
8.26The use of telehealth to deliver services must be medically appropriate to the condition and
8.27needs of the person being served. Reimbursement shall be at the same rates and under the
8.28same conditions that would otherwise apply to direct face-to-face services.
8.29 (g) For the purpose of reimbursement under this section, substance use disorder treatment
8.30services provided in a group setting without a group participant maximum or maximum
8.31client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
8.32At least one of the attending staff must meet the qualifications as established under this
8Sec. 3.
REVISOR DTT/HL 25-0274602/21/25 9.1chapter for the type of treatment service provided. A recovery peer may not be included as
9.2part of the staff ratio.
9.3 (h) Payment for outpatient substance use disorder services that are licensed according
9.4to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
9.5prior authorization of a greater number of hours is obtained from the commissioner.
9.6 (i) Payment for substance use disorder services under this section must start from the
9.7day of service initiation, when the comprehensive assessment is completed within the
9.8required timelines.
9.9 (j) A license holder that is unable to provide all residential treatment services because
9.10a client missed services remains eligible to bill for the client's intensity level of services
9.11under this paragraph if the license holder can document the reason the client missed services
9.12and the interventions done to address the client's absence.
9.13 (k) Hours in a treatment week may be reduced in observance of federally recognized
9.14holidays.
9.15 (l) Eligible vendors of peer recovery support services must:
9.16 (1) submit to a review by the commissioner of up to ten percent of all medical assistance
9.17and behavioral health fund claims to determine the medical necessity of peer recovery
9.18support services for entities billing for peer recovery support services individually and not
9.19receiving a daily rate; and
9.20 (2) limit an individual client to 14 hours per week for peer recovery support services
9.21from an individual provider of peer recovery support services.
9.22 (m) Peer recovery support services not provided in accordance with section 254B.052
9.23are subject to monetary recovery under section 256B.064 as money improperly paid.
9.24 Sec. 4. [256G.061] WITHDRAWAL MANAGEMENT SERVICES.
9.25 The county of financial responsibility for withdrawal management services is defined
9.26in section 256G.02, subdivision 4.
9Sec. 4.
REVISOR DTT/HL 25-0274602/21/25