HF98

Purpose

• This bill makes changes to how certain mental health services are supervised and delivered in Minnesota. It updates case management requirements, modifies supervision for frontline mental health workers, adjusts certain client rights for intensive residential treatment and residential crisis stabilization, strengthens critical incident reporting and treatment planning in residential settings, updates staffing and roles for Assertive Community Treatment (ACT) teams, and adds a provision allowing payment for case management contacts conducted by secure electronic messaging. It amends several sections of Minnesota statutes to implement these changes.

Main Provisions

• Case management supervision and qualifications (Section 1)

  • Defines who can be a case management service provider and what they must know and do.
  • Requires case managers to be a mental health practitioner or have a bachelor’s degree in behavioral sciences or related fields; if not, they must meet alternative qualifications.
  • Sets supervision and continuing education requirements for case managers and case management associates (CMAs); CMAs must work under supervision and meet specific training and mentoring rules.
  • Creates pathways for case managers with varying backgrounds, including an immigrant CMA option with training and supervision.
  • Allows payment for adult mental health case management contacts conducted via secure electronic messaging.

• Supervision for certain frontline workers (Section 2)

  • Requires direct observation and regular supervision of mental health behavioral aides (MHBA) and mental health rehabilitation workers (MHRW).
  • Specifies the minimum frequency of direct observation and supervision, especially during the first six months of employment and thereafter.

• Client rights and grievance process (Sections 3–4)

  • Keeps the health care bill of rights for clients, but notes that certain sections of that bill do not apply to intensive residential treatment services (IRTS) or residential crisis stabilization services (RCS).
  • Requires license holders to protect rights including non-discrimination and privacy around recording, with options to refuse photos or recordings not used for identification or supervision.
  • Strengthens grievance procedures: clearly explain them at admission, post the procedures, allow complaints to be filed by clients or their representatives, acknowledge receipt within 3 business days, provide a final written response within a set period, and allow appeals for managed care reductions or denials. Prohibits retaliation for grievances.

• Critical incidents reporting (Section 5)

  • If a license holder runs a residential program, they must report all critical incidents to the state commissioner within 10 days using an approved form.
  • Keeps a central file of critical incidents accessible to the commissioner.
  • Provides exceptions if the incident has already been reported to an Ombudsman or the Minnesota Adult Abuse Reporting Center.

• Intensive Residential Treatment Services (IRTS) assessment and treatment planning (Section 6)

  • Sets timelines for initial evaluation and treatment planning after a client’s admission (e.g., within 12 hours for immediate needs; within 24 hours for an initial treatment plan).
  • Requires level of care assessments within 5–10 days and again within 60 days; ensures medical necessity is documented if needed.
  • Requires ongoing updates to diagnostic assessments and treatment plans, with a focus on preparing the client for a successful transition from IRTS to another setting.
  • Calls for explicit documentation of referrals, resources, and who is responsible for following up.
  • Requires assessments of substance use history and its impact, including relationships, housing, finances, and safety.
  • Requires weekly reviews of treatment plans and abuse prevention plans by qualified professionals, with documentation in the client’s file.
  • Includes specific requirements for substance use assessments and ongoing monitoring for clients with substance use disorders.

• ACT team staffing and roles (Section 7)

  • Reframes ACT team structure and qualifications:
  • Team leader must be a mental health professional and a full-time, dedicated staff member who can provide after-hours support.
  • Psychiatric care providers, nursing staff, cooccurring disorder specialists, vocational specialists, mental health certified peer specialists, and a program administrative assistant are defined roles with specific responsibilities and staffing rules.
  • Sets limits on how many staff can occupy certain roles (e.g., no more than two cooccurring disorder specialists; no more than two psychiatric care providers sharing the same role) and requires certain full-time equivalents based on client load.
  • Psychiatric care providers must have experience with serious and persistent mental illness, work closely with the ACT team, and handle medication education, monitoring, and communication with inpatient teams as needed.
  • Nursing staff manage medications, monitor health, and coordinate with the rest of the ACT team.
  • Cooccurring disorder specialists must have specific training in cooccurring disorders and can be licensed professionals (e.g., licensed alcohol and drug counselors) meeting certain criteria.
  • Vocational specialists provide employment and education services and must not refer clients outside the ACT framework for vocational services.
  • Mental health certified peer specialists provide recovery-focused coaching and support and must be integrated as full team members without compromising their role.
  • Each ACT team must document schedules, designate a primary team member for each client (responsible for the individual treatment plan and family support), and ensure all team members have appropriate training and collaborate as a multidisciplinary team.
  • Emphasizes training requirements for all ACT team members and the need for a collaborative, client-centered approach.

Significant Changes to Existing Law

• Exemption from certain health care rights for IRTS/RCS: Some sections of the health care bill of rights do not apply to intensive residential treatment services or residential crisis stabilization services.
• Expanded supervision and education requirements: More explicit and frequent supervision and direct observation for case managers, CMAs, MHBA, and MHRW.
• Stricter and clearer ACT team structure: Redefined roles, staffing ratios, after-hours coverage, and multi-disciplinary collaboration requirements for ACT teams.
• New and revised reporting requirements: Enhanced critical incident reporting, ongoing treatment plan reviews, and substance use assessments with documented follow-up.
• Broader pathways and qualification options: New or expanded routes for CMAs and other frontline staff to meet requirements (including immigrant pathways and various combinations of education and experience).
• Electronic communications: Authorization and payment for case management contacts conducted via secure electronic messaging.

Impact Focus (Who is Affected)

• Providers delivering case management, MHBA, MHRW, and other ACT-related services will face new or changed supervision, training, and staffing rules.
• Residential programs offering IRTS or RCS will see changes to client rights, incident reporting, and treatment planning timelines.
• Clients receiving mental health services, particularly in residential or community-based settings, may experience changes in supervision quality, treatment planning, grievance processes, and access to services through secure electronic messaging.

Relevant Terms - case management, case manager, case management associate (CMA), CMA supervision, case management supervisor - mental health behavioral aide (MHBA), mental health rehabilitation worker (MHRW), direct observation - intensive residential treatment services (IRTS), residential crisis stabilization services (RCS) - assertive community treatment (ACT) team, ACT team leader, psychiatric care provider, nursing staff - cooccurring disorder specialist, vocational specialist, mental health certified peer specialist - emergency reporting, critical incidents, licensing, commissioner - level of care assessment, initial treatment plan, individual treatment plan, treatment supervisor - substance use disorder (SUD), substance use assessment - health care bill of rights, discrimination protections, grievance procedure - secure electronic messaging, remote case management - immigrant CMA pathway, mentoring, supervision hours