Reform Concepts Under Consideration - Minnesota



Behavioral Health DivisionReform Concepts Under ConsiderationBased on Stakeholder InputCulturally Specific/Special PopulationsShort Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?* Modify the enhanced rate requirements. Currently, to qualify as a culturally specific/special populations program, at least 50 percent of treatment staff must be of the culture or special population. We recommend legislation to modify the enhanced rate requirements to allow non-treatment program staff to count toward the 50 percent when providing cultural services. DHS is no longer in support of.Stakeholder engagement. Conduct meaningful stakeholder engagement that is transparent and committed to honestly and persistently working through conflicts and challenges.Funding for culturally specific providers. Seek non-Medicaid funding opportunities for culturally specific providers such as traditional healers or other unlicensed individuals who provide cultural services to support a client’s treatment goals.Decrease disparities in outcomes. Support the development of culturally appropriate and effective treatment modalities that decrease disparities in outcomes.Develop standards with stakeholders. Work with stakeholders to consider external standards that could be undertaken to improve the quality and inclusiveness of a program. Explore how culturally competent and inclusive services could also be achieved through staff training requirements and specific attention to clients’ needs and desires.Workforce development. Work with stakeholders to support workforce development that increases the number of providers competent to provide culturally specific services and encourages a workforce with increased demographic diversity.Prevention funding for underserved communities. Seek increased prevention funding to target underserved communities experiencing disparities. Develop prevention efforts with a holistic and tailored focus for different populationsInput additional ideas here:Opioids & OTP’sShort Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?* Per diem reimbursement. Eliminate the per diem reimbursement methodology of opioid treatment programs, but retain the basic per diem for the medications and allow opioid treatment programs to bill hourly for non-residential behavioral support services.* Prescription Monitoring Program. Require programs to ask patients to voluntarily sign a written consent to permit the disclosure of medications dispensed for the treatment of opioid addiction to the Minnesota Prescription Monitoring Program. Not giving consent would have no effect on their ability to receive treatment services.Positive drug test reporting. Require opioid treatment programs to report to DHS how many clients receiving “take-home” doses have unexpected drug test results and mandating under what circumstances the program must revoke client’s right of ‘take-homes” following problematic drug tests. DHS is no longer in support of. Recommended changes: Require that the medical director be informed of each diversion control measure that identifies a situation where there was a possible diversion issue.Support persons on medically assisted treatment. Identify incentives for providers to accept people receiving medically assisted treatment (MAT) for opioid dependence. Currently clinics treating people using MAT may not offer a full range of behavioral treatment services. Meanwhile, many treatment providers who focus on behavioral strategies may feel a disincentive to accepting MAT patients. Therefore, treatment providers who focus on behavioral strategies need to be incentivized to accept MAT clients to insure people receive a full range of needed services.Naloxone availability. Support the increased availability of naloxone and support providing clients with access to Naloxone upon discharge.Barriers to behavioral support. Monitor barriers to behavioral support services for individuals who use medication-assisted treatment. Continue stakeholder engagement to ensure appropriate access to behavioral supports across the state for all clients, including those engaging in medication assisted treatment.Input on Opioid Navigator Roles. These would be an opioid specific outreach and coordination role to connect individuals with an opioid use disorder to resources such as SUD treatment, medical appointments, housing, etc.Input additional ideas here:Withdrawal ManagementShort Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?*Withdrawal management. Add Minnesota Statutes, Chapter 245F withdrawal management services to the state’s Medicaid benefit set. Withdrawal management services include the provision of treatment services, including care coordination and peer support services. Withdrawal management programs will increase linkages for clients and provide support through either more treatment or connection to support in their community. In addition to freestanding withdrawal management programs, opportunities for programs to provide 245F services in 245G and other appropriate settings will be explored. 245FDeletes requirement for statement of need for a new or expanding WM program to facilitate quicker implementation, reflect the reality that programs receive clients from statewide geographic areas and reduce paperwork.Allow tribally and DHS licensed WM programs that are participating in the 1115 waiver project and are eligible for federal financial participation to begin providing and be reimbursed for WM services July 1, 2018, or upon approval of the federal waiver, whichever is later. 254BRemove requirement to submit an annual financial statement.Input additional ideas here:Primary PreventionShort Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?* Prevention planning and implementation. Expand the Prevention Planning and Implementation Program, which focuses on environmental strategies and has demonstrated positive outcomes and improved health.* More RPCs. Increase the number of Regional Prevention Coordinators (RPCs), which provide training and technical assistance on substance use prevention. Currently, the state is divided into seven large geographical areas covered by RPCs. Increased investment in this program would allow each RPC to have a smaller geographical area and permit more concentrated efforts.Input additional ideas here:Problem GamblingShort Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?Cross-addiction education. Support increased education regarding the risks of cross-addiction when treating gambling disorder or substance use disorder. Support increased cross-referral, integrated treatment services and continuing care when providing services to individuals with gambling and substance use disorder.Ensure best practices. Work with stakeholders to enhance the current requirements to ensure the use of best practices and person-centered recovery-driven outcomes. Telehealth. Support increased use of telehealth to expand access to problem gambling treatment. Increase awareness of telehealth technical assistance opportunities and the availability of teleconferencing services.Research. Establish and develop research to provide data-driven decision-making.Input additional ideas here:245GShort Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?Comprehensive assessment. 245G.05 Subd. 1Current statute requires the Comprehensive assessment to be completed by an alcohol and drug abuse counselor. Allowing multi-disciplinary licensed staff, such as registered nurse or licensed mental health professional to complete areas of the assessment that are in the differently-licensed professional staff’s scope of practice, with a requirement for the alcohol and drug counselor to ensure the comprehensive assessment is complete and accurate.Input additional ideas here:WorkforceShort Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?Rule 25 County Workforce Preservation254A.03 Subd. 3? …(c) Notwithstanding section 254B.05, subdivision 5, paragraph (c), an individual employed by a county on July 1, 2018 who has been performing assessments for the purpose of 9530.6615 is qualified to do a comprehensive assessment if the following conditions are met on July 1, 2018:The individual is exempt from licensure under section 148F.11, subdivision 1;The individual is qualified as an assessor under Minnesota Rules part 9530.6615, subpart 2; and(3) The individual has three years employment as an assessor or is under the supervision of an individual who meets the requirements of an alcohol and drug counselor supervisor under 245G.11, subdivision 4.? After June 30, 2020, an individual qualified to do a comprehensive assessment under this paragraph must additionally demonstrate completion of the applicable coursework requirements of 245G.11, subdivision 5, paragraph (b).Increasing diversity and capacity of the SUD Workforce in collaboration with essential boards, associations and licensing agencies (Minnesota Certification Board, Social Work, Nursing, Board Behavioral Health and Therapy (BBHT), Department of Employment and Economic Development, Minnesota Association of Resources for Recovery and Chemical Health (MARRCH)), the 2016 Workforce/Licensing workgroup recommended that DHS examine disparities in education and the potential to revise licensing requirements to include tiered licensing options. ? In collaboration with stakeholders [treatment providers, Minnesota Certification Board, consumers, Minnesota Coalition of Addiction Studies Education (MN CASE)], increase cultural competence through education and training. ? In collaboration, DHS, other state agencies and stakeholders, improve longitudinal data collection regarding demographics (cultural/ethnicity) of clinical workforce, client population, outcome measures [BBHT, Drug and Alcohol Abuse Normative Evaluation System (DAANES), MARRCH, Minnesota Association of Treatment Directors (MATD)].Accomplished in 2017 session: Modifies policy requirements for personnel policies to permit programs increased discretion to respond to individuals who may participate in treatment for substance use disorder or in other ways may experience symptoms of substance use disorder during employment, where previously programs were required to remove staff from direct access for two years following an incident or treatment participation. (align with 245G)? Coordinate efforts with BBHT regarding current legislation to examine a tiered workforce system capable of providing the entire continuum of effective efficient SUD treatment and recovery support services.Input additional ideas here:Insurance plan coverage for enrolled members who are court ordered or committedRequire insurance plans to cover enrolled members who are court-ordered or committed to substance use disorder treatment.Short Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?This proposal is modeled after 62Q.535 which requires plans to provide coverage for mental health treatment who are court-ordered or committed. This proposal supports parity. Rule 25 assessment for individuals with DWI offenseMinnesota Statutes, section 169A.70 requires use of the Rule 25 assessment for individuals with DWI offense. With the Rule 25 being phased out by July 2020, this language needs to be changed to identify the comprehensive assessment to be used instead of the rule 25 assessment.Short Description of the TopicStill in support of?Recommended changes?Additional things to consider?Would you like to be contacted to speak on this topic at a webex?Ten years ago, DHS and DPS met to discuss what type of assessment would be appropriate to require of individuals convicted of DWI. The Rule 25 Assessment was the agreed-upon assessment at that time and this requirement was enacted in 169A.70. To prepare for the upcoming phase-out of the Rule 25 Assessment, this proposal changes the statute to require comprehensive assessment for individuals convicted of DWI instead of the Rule 25 Assessment. DHS, Counties and DPS continue to engage in conversations and will all need to support this change, and this may need to come from DPS agency bill. We do not expect opposition. Additional Ideas, comments, considerations please Add Here ................
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