§ 256B.761 — REIMBURSEMENT FOR MENTAL HEALTH SERVICES

Minnesota § 256B.761

• Jurisdiction: Minnesota
• Part: PUBLIC WELFARE AND RELATED ACTIVITIES
• Ch. 256B: MEDICAL ASSISTANCE FOR NEEDY PERSONS

Text

Subdivision 1.Rates effective 2026.
(a) Effective for services rendered on or after January 1, 2026, or on or after the date of federal approval, whichever is later, the commissioner must establish and pay market-based payment rates for the following services:
(1) children's therapeutic services and supports under section256B.0943;
(2) child and family psychoeducation services under section256B.0671, subdivision 5;
(3) clinical care consultation services under section256B.0671, subdivision 7;
(4) mental health certified family peer specialist services under section256B.0616;
(5) adult day treatment services under section256B.0671, subdivision 3;
(6) adult rehabilitative mental health services under section256B.0623;
(7) adult mental health peer support specialist services under section256B.0615;
(8) dialectical behavioral therapy under section256B.0671, subdivision 6;
(9) explanation of findings under section256B.0671, subdivision 4;
(10) mental health crisis response services under section256B.0624;
(11) mental health provider travel time under section256B.0625, subdivision 43;
(12) neuropsychological testing under section256B.0671, subdivision 9;
(13) partial hospitalization services under section256B.0671, subdivision 12; and
(14) psychotherapy services under section256B.0671, subdivision 11, incorporating biofeedback.
(b) Rates established under paragraph (a) must:
(1) be based on the costs of the following factors:
(i) direct staff worker wages and benefits;
(ii) direct staff worker productivity;
(iii) program-related expenses; and
(iv) administrative costs; and
(2) must not be lower than:
(i) the payment rates recommended in the rate analysis required by Laws 2021, First Special Session chapter 7, article 17, section 18, and published by the Department of Human Services on January 22, 2024; or
(ii) the payment rates in effect on December 31, 2025.

Subd. 2.Capitation payments.
Managed care and county-based purchasing plans must reimburse providers at an amount that is at least equal to the fee-for-service rate for services under this section. The commissioner must monitor the effect of this rate adjustment on enrollee access to behavioral health services. If for any contract year federal approval is not received for this subdivision, the commissioner must adjust the capitation rates paid to managed care plans and county-based purchasing plans for that contract year to reflect the removal of this provision. Contracts between managed care plans and county-based purchasing plans and providers to whom this subdivision applies must allow recovery of payments from those providers if capitation rates are adjusted in accordance with this subdivision. Payment recoveries must not exceed the amount equal to any increase in rates that results from this subdivision.

Subd. 3.Inflation adjustment.
The commissioner must adjust the reimbursement rate for services under this section annually according to the change from the midpoint of the previous rate year to the midpoint of the rate year for which the rate is being determined using the Centers for Medicare and Medicaid Services Medicare Economic Index as forecasted in the fourth quarter of the calendar year before the rate year.

Subd. 4.Exceptions.
This section does not apply to federally qualified health centers, rural health centers, Indian health services, or certified community behavioral health clinics or to cost-based rates or rates that are negotiated with the county.

Legislative History

1Sp2001 c 9 art 9 s 43;2002 c 379 art 1 s 113;1Sp2003 c 14 art 2 s 40;2010 c 303 s 6;2013 c 108 art 4 s 28;1Sp2017 c 6 art 4 s 52;2018 c 182 art 1 s 54;2021 c 30 art 17 s 108;2023 c 70 art 1 s 35;2024 c 80 art 8 s 68;2024 c 127 art 61 s 28;1Sp2025 c 3 art 8 s 29;1Sp2025 c 9 art 4 s 48