Subd. 2a.

Eligibility for assertive community treatment.

An eligible client for assertive
community treatment is an individual who meets the following criteria as assessed by an
ACT team:

(1) is age 18 or older. Individuals ages 16 and 17 may be eligible upon approval by the
commissioner;

(2) has a primary diagnosis of schizophrenia, schizoaffective disorder, major depressive
disorder with psychotic features, other psychotic disorders, or bipolar disorder. Individuals
with other psychiatric illnesses may qualify for assertive community treatment if they have
a serious mental illness and meet the criteria outlined in clauses (3) and (4), but no more
than ten percent of an ACT team's clients may be eligible based on this criteria. Individuals
with a primary diagnosis of a substance use disorder, intellectual developmental disabilities,
borderline personality disorder, antisocial personality disorder, traumatic brain injury, or
an autism spectrum disorder are not eligible for assertive community treatment;

(3) has significant functional impairment as demonstrated by at least one of the following
conditions:

(i) significant difficulty consistently performing the range of routine tasks required for
basic adult functioning in the community or persistent difficulty performing daily living
tasks without significant support or assistance;

(ii) significant difficulty maintaining employment at a self-sustaining level or significant
difficulty consistently carrying out the head-of-household responsibilities; or

(iii) significant difficulty maintaining a safe living situation;

(4) has a need for continuous high-intensity services as evidenced by at least two of the
following:

(i) two or more psychiatric hospitalizations or residential crisis stabilization services in
the previous 12 months;

(ii) frequent utilization of mental health crisis services in the previous six months;

(iii) 30 or more consecutive days of psychiatric hospitalization in the previous 24 months;

(iv) intractable, persistent, or prolonged severe psychiatric symptoms;

(v) coexisting mental health and substance use disorders lasting at least six months;

(vi) recent history of involvement with the criminal justice system or demonstrated risk
of future involvement;

(vii) significant difficulty meeting basic survival needs;

(viii) residing in substandard housing, experiencing homelessness, or facing imminent
risk of homelessness;

(ix) significant impairment with social and interpersonal functioning such that basic
needs are in jeopardy;

(x) coexisting mental health and physical health disorders lasting at least six months;

(xi) residing in an inpatient or supervised community residence but clinically assessed
to be able to live in a more independent living situation if intensive services are provided;

(xii) requiring a residential placement if more intensive services are not available; deleted text begin or
deleted text end

(xiii) difficulty effectively using traditional office-based outpatient services;new text begin or
new text end

new text begin (xiv) receiving services through a program that meets the requirements for the first
episode of psychosis grant program under section 245.4905 and having been determined to
need an ACT team;
new text end

(5) there are no indications that other available community-based services would be
equally or more effective as evidenced by consistent and extensive efforts to treat the
individual; and

(6) in the written opinion of a licensed mental health professional, has the need for mental
health services that cannot be met with other available community-based services, or is
likely to experience a mental health crisis or require a more restrictive setting if assertive
community treatment is not provided.

Subd. 3a.

Provider certification and contract requirements for assertive community
treatment.

(a) The assertive community treatment provider mustdeleted text begin :
deleted text end

deleted text begin (1) have a contract with the host county to provide assertive community treatment
services; and
deleted text end

deleted text begin (2)deleted text end have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section,
the standards in chapter 245I as required in section 245I.011, subdivision 5, and minimum
program fidelity standards as measured by a nationally recognized fidelity tool approved
by the commissioner. Recertification must occur at least every three years.

(b) An ACT team certified under this subdivision must meet the following standards:

(1) have capacity to recruit, hire, manage, and train required ACT team members;

(2) have adequate administrative ability to ensure availability of services;

(3) ensure flexibility in service delivery to respond to the changing and intermittent care
needs of a client as identified by the client and the individual treatment plan;

(4) keep all necessary records required by law;

(5) be an enrolled Medicaid provider; and

(6) establish and maintain a quality assurance plan to determine specific service outcomes
and the client's satisfaction with services.

(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.

Subd. 7a.

Assertive community treatment team staff requirements and roles.

(a)
The required treatment staff qualifications and roles for an ACT team are:

(1) the team leader:

(i) shall be a mental health professional. Individuals who are not licensed but who are
eligible for licensure and are otherwise qualified may also fulfill this role deleted text begin but must obtain
full licensure within 24 months of assuming the role of team leaderdeleted text end ;

(ii) must be an active member of the ACT team and provide some direct services to
clients;

(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the teamdeleted text begin , providing treatment
supervision of services in conjunction with the psychiatrist or psychiatric care provider,deleted text end and
supervising team members to ensure delivery of best and ethical practices; and

(iv) must be available to deleted text begin providedeleted text end new text begin ensure thatnew text end overall treatment supervision to the ACT
team new text begin is available new text end after regular business hours and on weekends and holidaysdeleted text begin . The team
leader may delegate this duty to anotherdeleted text end new text begin , and is provided by anew text end qualified member of the ACT
team;

(2) the psychiatric care provider:

(i) must be a mental health professional permitted to prescribe psychiatric medications
as part of the mental health professional's scope of practice. The psychiatric care provider
must have demonstrated clinical experience working with individuals with serious and
persistent mental illness;

(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide
treatment supervision to the team;

(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;

(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;

(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role; and

(vi) shall provide psychiatric backup to the program after regular business hours and on
weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;

(3) the nursing staff:

(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;

(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and

(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;

(4) the co-occurring disorder specialist:

(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledg