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.
1.7BE 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
1.10a clinically significant disorder of thought, mood, perception, orientation, memory, or
1.11behavior that is detailed in a diagnostic codes list published by the commissioner, and that
1.12seriously limits a person's capacity to function in primary aspects of daily living such as
1.13personal 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
1.15serious enough to require prompt intervention.
1.16 (c) For purposes of case management and community support services, a "person with
1.17serious and persistent mental illness" means an adult who has a mental illness and meets at
1.18least one of the following criteria:
1.19 (1) the adult has undergone two or more episodes of inpatient care for a mental illness
1.20within the preceding 24 months;
1.21 (2) the adult has experienced a continuous psychiatric hospitalization or residential
1.22treatment exceeding six months' duration within the preceding 12 months;
1Section 1.
25-04214 as introduced02/27/25 REVISOR DTT/AD
SENATE
STATE OF MINNESOTA
S.F. No. 2358NINETY-FOURTH SESSION
(SENATE AUTHORS: KUNESH)
OFFICIAL STATUSD-PGDATE
Introduction and first reading03/10/2025
Referred to Health and Human Services 2.1 (3) the adult has been treated by a crisis team two or more times within the preceding
2.224 months;
2.3 (4) the adult:
2.4 (i) has a diagnosis of schizophrenia, bipolar disorder, major depression, schizoaffective
2.5disorder, 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,
2.8stating that the adult is reasonably likely to have future episodes requiring inpatient or
2.9residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
2.10management 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
2.12mentally 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
2.14expired or the adult was eligible as a child under section 245.4871, subdivision 6; and (ii)
2.15has a written opinion from a mental health professional, in the last three years, stating that
2.16the adult is reasonably likely to have future episodes requiring inpatient or residential
2.17treatment, of a frequency described in clause (1) or (2), unless ongoing case management
2.18or 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
2.2021 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
2.23illness and meets the following criteria:
2.24 (1) the adult has PTSD symptoms that significantly interfere with daily functioning
2.25related 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
2.27documentation of:
2.28 (i) culturally sensitive assessments or screenings and identification of intergenerational,
2.29racial, or historical trauma;
2.30 (ii) significant impairment in functioning due to the PTSD symptoms that meet C-PTSD
2.31condition eligibility; and
2Section 1.
25-04214 as introduced02/27/25 REVISOR DTT/AD 3.1 (iii) increasing concerns within the last three years to indicate that the adult is at a
3.2reasonable likelihood of experiencing significant episodes of PTSD with increased frequency,
3.3impacting daily functioning unless mitigated by targeted case management or community
3.4support services.
3.5 EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
3.6of 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
3.9treatment services, outpatient treatment, community support services, residential treatment,
3.10acute care hospital inpatient treatment, or regional treatment center inpatient treatment must
3.11inform each of its clients with serious and persistent mental illness or a complex
3.12post-traumatic stress disorder of the availability and potential benefits to the client of case
3.13management. If the client consents, the provider must refer the client by notifying the county
3.14employee designated by the county board to coordinate case management activities of the
3.15client's name and address and by informing the client of whom to contact to request case
3.16management. The provider must document compliance with this subdivision in the client's
3.17record.
3.18 EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
3.19of 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
3.22county board shall provide case management services for all adults with serious and persistent
3.23mental illness or a complex post-traumatic stress disorder who are residents of the county
3.24and who request or consent to the services and to each adult for whom the court appoints a
3.25case manager. Staffing ratios must be sufficient to serve the needs of the clients. The case
3.26manager must meet the requirements in section 245.462, subdivision 4.
3.27 (b) Case management services provided to adults with serious and persistent mental
3.28illness or a complex post-traumatic stress disorder eligible for medical assistance must be
3.29billed to the medical assistance program under sections 256B.02, subdivision 8, and
3.30256B.0625.
3.31 (c) Case management services are eligible for reimbursement under the medical assistance
3.32program. Costs associated with mentoring, supervision, and continuing education may be
3Sec. 3.
25-04214 as introduced02/27/25 REVISOR DTT/AD 4.1included in the reimbursement rate methodology used for case management services under
4.2the medical assistance program.
4.3 EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
4.4of 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
4.7individual community support plan for each adult that incorporates the client's individual
4.8treatment plan. The individual treatment plan may not be a substitute for the development
4.9of an individual community support plan. The individual community support plan must be
4.10developed within 30 days of client intake and reviewed at least every 180 days after it is
4.11developed, unless the case manager receives a written request from the client or the client's
4.12family for a review of the plan every 90 days after it is developed. The case manager is
4.13responsible for developing the individual community support plan based on a diagnostic
4.14assessment and a functional assessment and for implementing and monitoring the delivery
4.15of services according to the individual community support plan. To the extent possible, the
4.16adult with serious and persistent mental illness or a complex post-traumatic stress disorder,
4.17the person's family, advocates, service providers, and significant others must be involved
4.18in 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
4.24need and the implementation of the individual community support plan.
4.25 EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
4.26of 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
4.29provide or contract for sufficient community support services within the county to meet the
4.30needs of adults with serious and persistent mental illness or a complex post-traumatic stress
4.31disorder who are residents of the county. Adults may be required to pay a fee according to
4Sec. 5.
25-04214 as introduced02/27/25 REVISOR DTT/AD 5.1section 245.481. The community support services program must be designed to improve
5.2the ability of adults with serious and persistent mental illness or a complex post-traumatic
5.3stress 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
5.10and use of more intensive, costly, or restrictive placements both in number of admissions
5.11and length of stay.
5.12 (b) Community support services are those services that are supportive in nature and not
5.13necessarily treatment oriented, and include:
5.14 (1) conducting outreach activities such as home visits, health and wellness checks, and
5.15problem 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
5.20a stable financial situation;
5.21 (6) fostering social support, including support groups, mentoring, peer support, and other
5.22efforts 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
5.25maintain the level of expenditures for this program, as required under section 245.4835.
5.26County boards must continue to provide funds for those services not covered by other
5.27funding streams and to maintain an infrastructure to carry out these services. The county is
5.28encouraged to fund evidence-based practices such as Individual Placement and Supported
5.29Employment and Illness Management and Recovery.
5.30 (d) The commissioner shall collect data on community support services programs,
5.31including, but not limited to, demographic information such as age, sex, race, the number
5Sec. 5.
25-04214 as introduced02/27/25 REVISOR DTT/AD 6.1of people served, and information related to housing, employment, hospitalization, symptoms,
6.2and satisfaction with services.
6.3 EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
6.4of 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
6.7and persistent mental illness or a complex post-traumatic stress disorder in applying for
6.8state and federal benefits, including Supplemental Security Income, medical assistance,
6.9Medicare, general assistance, and Minnesota supplemental aid. The help must be offered
6.10as part of the community support program available to adults with serious and persistent
6.11mental illness or a complex post-traumatic stress disorder for whom the county is financially
6.12responsible 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
6.15state agency, medical assistance covers case management services to persons with serious
6.16and persistent mental illness, persons with a complex post-traumatic stress disorder, and
6.17children with severe emotional disturbance. Services provided under this section must meet
6.18the relevant standards in sections 245.461 to 245.4887, the Comprehensive Adult and
6.19Children's Mental Health Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and
6.209505.0322, excluding subpart 10.
6.21 (b) Entities meeting program standards set out in rules governing family community
6.22support services as defined in section 245.4871, subdivision 17, are eligible for medical
6.23assistance reimbursement for case management services for children with severe emotional
6.24disturbance when these services meet the program standards in Minnesota Rules, parts
6.259520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
6.26 (c) Medical assistance and MinnesotaCare payment for mental health case management
6.27shall be made on a monthly basis. In order to receive payment for an eligible child, the
6.28provider must document at least a face-to-face contact either in person or by interactive
6.29video that meets the requirements of subdivision 20b with the child, the child's parents, or
6.30the child's legal representative. To receive payment for an eligible adult, the provider must
6.31document:
6Sec. 7.
25-04214 as introduced02/27/25 REVISOR DTT/AD 7.1 (1) at least a face-to-face contact with the adult or the adult's legal representative either
7.2in 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
7.4document a face-to-face contact either in person or by interactive video that meets the
7.5requirements of subdivision 20b with the adult or the adult's legal representative within the
7.6preceding two months.
7.7 (d) Payment for mental health case management provided by county or state staff shall
7.8be 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
7.10health, separate rates for children and adults.
7.11 (e) Payment for mental health case management provided by Indian health services or
7.12by agencies operated by Indian tribes may be made according to this section or other relevant
7.13federally approved rate setting methodology.
7.14 (f) Payment for mental health case management provided by vendors who contract with
7.15a county must be calculated in accordance with section 256B.076, subdivision 2. Payment
7.16for mental health case management provided by vendors who contract with a Tribe must
7.17be based on a monthly rate negotiated by the Tribe. The rate must not exceed the rate charged
7.18by the vendor for the same service to other payers. If the service is provided by a team of
7.19contracted vendors, the team shall determine how to distribute the rate among its members.
7.20No reimbursement received by contracted vendors shall be returned to the county or tribe,
7.21except to reimburse the county or tribe for advance funding provided by the county or tribe
7.22to the vendor.
7.23 (g) If the service is provided by a team which includes contracted vendors, tribal staff,
7.24and county or state staff, the costs for county or state staff participation in the team shall be
7.25included in the rate for county-provided services. In this case, the contracted vendor, the
7.26tribal agency, and the county may each receive separate payment for services provided by
7.27each entity in the same month. In order to prevent duplication of services, each entity must
7.28document, in the recipient's file, the need for team case management and a description of
7.29the roles of the team members.
7.30 (h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
7.31mental health case management shall be provided by the recipient's county of responsibility,
7.32as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
7.33used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
7.34share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
7Sec. 7.
25-04214 as introduced02/27/25 REVISOR DTT/AD 8.1without a federal share through fee-for-service, 50 percent of the cost shall be provided by
8.2the recipient's county of responsibility.
8.3 (i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
8.4and MinnesotaCare include mental health case management. When the service is provided
8.5through prepaid capitation, the nonfederal share is paid by the state and the county pays no
8.6share.
8.7 (j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
8.8that does not meet the reporting or other requirements of this section. The county of
8.9responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
8.10is responsible for any federal disallowances. The county or tribe may share this responsibility
8.11with its contracted vendors.
8.12 (k) The commissioner shall set aside a portion of the federal funds earned for county
8.13expenditures under this section to repay the special revenue maximization account under
8.14section 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
8.18this section shall only be made from federal earnings from services provided under this
8.19section. When this service is paid by the state without a federal share through fee-for-service,
8.2050 percent of the cost shall be provided by the state. Payments to county-contracted vendors
8.21shall 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,
8.23legal, or outreach services.
8.24 (n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
8.25and the recipient's institutional care is paid by medical assistance, payment for case
8.26management 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
8.28than 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
8.31payments made under other program authorities for the same purpose.
8Sec. 7.
25-04214 as introduced02/27/25 REVISOR DTT/AD 9.1 (p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
9.2licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
9.3mental health targeted case management services must actively support identification of
9.4community alternatives for the recipient and discharge planning.
9.5 EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
9.6of human services shall notify the revisor of statutes when federal approval is obtained.
9Sec. 7.
25-04214 as introduced02/27/25 REVISOR DTT/AD