SF3734

Purpose

This bill makes changes to how intensive residential treatment services (IRTS) and intensive nonresidential rehabilitative mental health services are provided and funded. It adds detailed assessment and planning requirements, expands the use of the behavioral health fund for substance use disorder treatment and related room-and-board costs, and strengthens staffing, supervision, and evaluation rules for nonresidential programs serving youth and young adults.

Key provisions for intensive residential treatment services (IRTS)

• Assessments and initial planning
  • Within 12 hours of admission: evaluate and document the client’s immediate needs, including health and safety, crisis needs, family and natural supports, housing, and legal issues.
  • Within 24 hours: complete an initial treatment plan based on referral information and the needs assessment; plan must include crisis strategies, initial treatment goals, measurable objectives, and specific interventions; the client must participate in planning, and a treatment supervisor must approve if the plan is prepared by a clinician in training.
  • An abuse prevention plan must be included as part of the client’s initial treatment plan.
• Ongoing planning and reviews
  • Within five days of admission and again within 60 days: complete a level of care assessment; if medically unnecessary for a higher level of care, the treatment supervisor must document medical necessity for continued IRTS.
  • Within ten days of admission: complete or update standard diagnostic assessment and the client’s individual treatment plan; update the plan again at 40 days and 70 days after admission.
  • The treatment plan must focus on preparing the client for a successful transition from IRTS to another setting and must include referrals/resources and the staff responsible for follow-up; if referrals are not made, the reason must be documented.
  • Within 30 days of admission: complete a functional assessment, with updates at 60 days to reflect changes in functioning and symptoms.
• Substance use disorder (SUD) considerations
  • For clients with a current SUD diagnosis or a positive SUD screen, a written SUD assessment must be completed within 30 days of admission, covering: history of relapses/hospitalizations, effects on relationships, finances, housing, unemployment, legal problems, victimization, suicide attempts, medication noncompliance, and treatment noncompliance.
• Weekly review
  • A mental health professional or certified rehabilitation specialist reviews each client’s treatment plan and abuse prevention plan weekly, with documentation in the client’s file.

Eligibility and funding implications (Behavioral Health Fund and room/board)

• Behavioral Health Fund eligibility for treatment
  • The bill sets criteria for when substance use disorder treatment can be paid for with Behavioral Health Fund money, including eligibility based on MFIP, medical assistance, MinnesotaCare, or income within specified guidelines, and the absence of a full third-party payer.
  • If eligible, funds may cover treatment and room/board costs under specified conditions; some eligibility is tied to whether the client has a third-party payer for part of the cost (in which case BH Fund may cover the remainder).
  • Certain conditions allow continued BH Fund-funded treatment if a client disenrolls from a state prepaid health plan mid-episode, until the episode ends and the client remains eligible for MA/MinnesotaCare/General Assistance medical care.
• Room and board eligibility
  • Room and board services may be paid for through the BH Fund for individuals enrolled in MinnesotaCare or medical assistance, or under specific sections that allow such payments; there is a limit of one 60-consecutive-calendar-day period per year for this benefit, with a process to request additional eligibility through the commissioner.
• Payment responsibilities and limitations
  • Counties may have payment responsibilities for certain placements (e.g., regional treatment centers) if BH Fund eligibility is lacking.
  • The bill clarifies that eligibility and funding are contingent on meeting the defined income guidelines, third-party payment status, and active enrollment in MA, MinnesotaCare, or related programs.

Standards and structure for intensive nonresidential rehabilitative mental health services (INRMS)

• Age-appropriate services
  • Providers must serve youth at least 8 years old up to under 16, or age 14 to under 21, with subgroups defined for age ranges.
• Core treatment team
  • A core team must have at least four full-time equivalent direct-care staff and includes:
  • A mental health professional who leads and supervises the team.
  • An advanced practice registered nurse with psychiatric training or a board-certified child/adolescent psychiatrist who can prescribe medications.
  • A mental health peer specialist (who is a former youth consumer and qualified per statute).
  • A cooccurring disorder specialist.
• Additional team members and consultants
  • The team may include additional mental health professionals, vocational/educational specialists, a clinician qualified as a trainee, a case management provider, housing access specialist, family peer specialist, and a registered nurse, among others.
  • The team may also include nonclinical, client-specific consultants (e.g., prior treating clinician, current SUD counselor, school-based specialists, health care home representative, juvenile justice representative, vocational counselor) who participate and are paid for by the provider.
• Team operations
  • The treatment supervisor must be an active team member and practice as a clinician, meeting weekly with the team to review progress and adjust the plan; client-specific case reviews and planning must be documented.
  • Staffing ratios: no more than 10 clients per 1 FTE on the core team; the team cannot serve more than 80 clients at once; if demand exceeds capacity, another team must be formed rather than increasing the current team size.
  • Nonclinical staff must have prompt in-person or phone access to a mental health professional or trainee to respond to urgent needs.
  • INRMS providers must participate in evaluating the Youth ACT model (assertive community treatment for youth), including data collection and reporting as specified by the contract.
  • Regional treatment teams may serve multiple counties.

Implementation and oversight considerations

• Regular evaluation and reporting
  • Programs must engage in ongoing evaluation, data collection, and performance reporting related to the Youth ACT model and other specified outcomes.
• Capacity and access
  • Caps on team size and client load aim to ensure timely access to care and appropriate staffing levels; if demand exceeds capacity, a new team must be created.
• Transition and integration
  • The focus on transition planning emphasizes moving clients from intensive services to less intensive settings when appropriate and coordinating with other services and supports.

Potential impacts and changes to practice

• More standardized and timely assessments and treatment planning for residential and nonresidential services.
• Expanded funding pathways for substance use treatment, including room and board in certain programs, with explicit eligibility rules.
• Stronger, multidisciplinary staffing models for youth-focused nonresidential services, with defined roles and regular team meetings.
• Increased emphasis on data, outcomes, and accountability through required participation in Youth ACT evaluation and reporting.

Relevant Terms - intensive residential treatment services (IRTS) - residential crisis services - behavioral health fund - room and board - initial treatment plan - level of care assessment - standard diagnostic assessment - individual treatment plan - abuse prevention plan - crisis assistance - substance use disorder (SUD) - substance use assessment - treatment supervisor - cooccurring disorder - Youth ACT (assertive community treatment for youth) - intensive nonresidential rehabilitative mental health services (INRMS) - core treatment team - mental health professional - advanced practice registered nurse (APRN) - psychiatrist (child/adolescent) - mental health peer specialist - case management - housing access specialist - educational/school-based supports - regional treatment team - third-party payer - MFIP (Minnesota-family investment program) - MinnesotaCare - medical assistance (MA) - regional treatment center - nonclinical staff - treatment team capacity and staffing ratios