HF3520

Purpose

• Modernize and expand requirements for intensive residential treatment services (IRTS) and intensive nonresidential rehabilitative mental health services.
• Improve how treatment is planned, documented, and coordinated; clarify when and how payment for room and board is covered through the behavioral health fund; and raise standards for service delivery, especially for youth and people with substance use disorders.

Key Provisions at a Glance

• The bill strengthens initial and ongoing treatment planning for Intensive Residential Treatment Services, including rapid assessments after admission, structured treatment plans, ongoing reviews, and clear steps toward transitioning to another setting.
• It expands who can access behavioral health fund money for substance use and related services, including room and board payments for certain publicly funded health coverage enrollees.
• It updates standards for Intensive Nonresidential Rehabilitative services, especially around staff makeup, team structure, size, supervision, and accountability (including Youth ACT-related reporting).

Section 1 — Intensive Residential Treatment Services: Assessment, Planning, and Monitoring

• Within 12 hours of admission: license holder must evaluate and document immediate needs (health and safety, crisis needs, supports from family/employers, housing, legal issues).
• Within 24 hours: complete an initial treatment plan based on referrals and assessed needs.
• Treatment planning details: include crisis strategies, measurable goals and objectives, specific interventions, and the participants in planning. The client must participate, and a treatment supervisor must approve the plan if created by a behavioral health practitioner or trainee.
• Abuse prevention: an individual abuse prevention plan must be part of the initial treatment plan.
• Level of care and medical necessity: complete a level-of-care assessment within five days of admission and 60 days after admission; if medical necessity isn’t met, a supervisor must document why continued intensive services are medically necessary.
• Diagnostic and treatment plan updates: update standard diagnostic assessment within 10 days; update the individual treatment plan within 10 days, and then again at 40 and 70 days to focus on a successful transition out of Residential Treatment Services.
• Referral tracking: include referrals and resources, plus the staff responsible for follow-up; if a needed referral isn’t made, document why.
• Weekly reviews: mental health professionals or certified rehabilitation specialists must review each client’s treatment plan and abuse prevention plan; each weekly review must be documented.
• Substance use disorder (SUD) assessment: for clients with a current SUD diagnosis or a screen indicating possible SUD, complete a written SUD assessment within 30 days, covering relapse history, relationship effects, financial/health/housing/unemployment problems, legal issues, violence/victimization, suicidality, medication adherence, and treatment noncompliance.
• Ongoing planning and review: weekly team reviews and documentation of client-specific case reviews.

Section 2 — Behavioral Health Fund and Room and Board Eligibility

• Eligibility for behavioral health fund services: room and board costs can be paid from the behavioral health fund for certain individuals not enrolled in medical assistance, with funds kept in a separate account.
• Access for dependents and SUD treatment: dependents who need SUD or chemical dependency treatment can be assisted; facilities may allow dependents to stay with the client during treatment; counties may cover related out-of-home placement costs.
• Room and board for MA/MinnesotaCare enrollees: MA or MinnesotaCare enrollees are eligible for room and board services when provided through intensive residential treatment or residential crisis services.
• Income and third-party payments: individuals who are MFIP, MA, GA, GAMC eligible, or who meet income guidelines and have a third-party payer that pays less than 100% of costs can access the behavioral health fund for SUD treatment.
• Disenrollment and continued eligibility: if a client is disenrolled from a prepaid health plan during treatment, they can continue to receive behavioral health fund services through the end of the treatment episode if they remain eligible.
• County responsibilities: counties may be responsible for payment to regional treatment centers if the client is ineligible for the behavioral health fund.
• Eligibility period and appeals: eligible for one 60-day period per year for room and board; requests for additional eligibility possible; denial can be appealed through a state agency hearing.
• Regional treatment centers: the county is responsible for payment if the client is ineligible for the behavioral health fund.
• Interaction with other programs: persons enrolled in MinnesotaCare or MA remain eligible for room and board when provided through IRTS and residential crisis services.
• Interaction with other coverage: if third-party payment covers part of the cost, the client may still be eligible for fund support if the third party pays less than 100% of costs.

Section 3 — Standards for Intensive Nonresidential Rehabilitative Providers

• Service standards: intensive nonresidential rehabilitative services must meet specified standards under the bill and the broader 245I framework.
• Age-focused treatment teams: teams must have specialized training for the age group served; youth teams serve either ages 8–15 or ages 14–20 (depending on program design).
• Core treatment team: must include at least four full-time equivalent direct care staff, including:
  • A team leader (mental health professional) for supervision and direction
  • An advanced practice registered nurse with psychiatric certification or a board-certified child/adolescent psychiatrist who can prescribe medications
  • A mental health certified peer specialist who is a former child mental health consumer
  • A cooccurring disorder (COD) specialist
• Additional team members: may include other mental health professionals, vocational and educational specialists, a school-based mental health provider, clinical trainees, case management, housing access specialists, family peer specialists, registered nurses, and other clinician-type roles.
• Ad hoc consultants: teams may include non-employees who consult on specific clients and are paid at standard rates; these members must follow the team’s clinical direction for the placement.
• Treatment supervision and meetings: the supervision physician or clinician must be an active team member; the team must meet at least weekly to discuss progress, with documentation of client-specific case reviews and planning.
• Staffing capacity: the team’s staff-to-client ratio must not exceed 10:1; the team must serve no more than 80 clients at a time; if demand exceeds capacity, a new team must be established rather than expanding beyond the limit.
• Access to nonclinical staff: nonclinical staff must have prompt in-person or phone access to mental health professionals and the ability to respond to emergencies quickly.
• Youth ACT evaluation: providers must participate in the evaluation of Youth ACT (assertive community treatment) models as conducted by the commissioner, including data collection and reporting of performance measures.
• Regional scope: regional treatment teams may serve multiple counties.

Notable Changes to Law and Practice

• Expanded payment and coverage rules for room and board under behavioral health fund, especially for MA/MinnesotaCare enrollees and various eligibility scenarios.
• Stronger, more detailed requirements for admission-to-treatment planning, ongoing plan updates, and weekly plan reviews for residential services.
• Clearer and more robust standards for nonresidential services, including team composition, supervision, client load caps, and data reporting.
• Emphasis on transition planning to prepare clients for moving to a different setting and on coordinating referrals and follow-up resources.

Relevant Terms - Intensive residential treatment services (IRTS) - Residential crisis services - Behavioral health fund - Room and board services - Initial treatment plan - Level of care assessment - Individual abuse prevention plan - Diagnostic assessment - Substance use disorder (SUD) assessment - Treatment plan review - Treatment supervisor - Cooccurring disorder (COD) specialist - Youth ACT - Regional treatment center - MinnesotaCare - Medical assistance (MA) - MFIP - GA / GAMC - Third-party payment - Family peer specialist - Advanced practice registered nurse (APRN) with psychiatry credentials - Certified peer specialist - Case management - Functional assessment - Health and safety, crisis planning - Transition planning / discharge planning