Mental-Health-Services-Overview by Orp92g


									Mental Health Services — Overview
Revised: 02-23-2011

Minnesota’s publicly provided mental health system, as reflected in the Minnesota Comprehensive Mental
Health Acts, is DHS-supervised and county-administered. Counties act as the local mental health
authority. Review Mental Health Provider Requirements for information about criteria to be an eligible
MHCP mental health provider.
Mental Health Covered Services
The following are covered mental health services:
 Crisis Services
    Adult Crisis Services
          Metro Area Residents (DHS-4485)
          Greater Minnesota Residents (DHS-4484)
    Children’s Mental Health Crisis Response Services
 Diagnostic Assessment (DA)
 Mental Health Targeted Case Management (MH-TCM)
 Mental Health Provider Travel Time
 Outpatient Mental Health Services
    Explanation of Findings
    Mental Health Medication Management
    Neuropsychological Services
    Psychotherapy
    Psychological Testing
 Rehabilitative Mental Health Services
    Assertive Community Treatment (ACT)
    Adult Day Treatment
    Adult Rehabilitative Mental Health Services (ARMHS)
    Certified Peer Specialist Support Services
    Children’s Mental Health Residential Treatment Services
    Children’s Therapeutic Services and Supports (CTSS)
          Children’s Day Treatment
    Intensive Residential Treatment Services (IRTS)
    Partial Hospitalization Program
 Physician Mental Health Services
    Health and Behavior Assessment/Intervention
    Inpatient Visits
    Psychiatric Consultations to Primary Care Providers
    Physician consultation, Evaluation and Management
Mental Health Service Continuum
The service continuum for mental health is composed of six key components:
1. Diagnostic assessment
2. Functional Assessment (Adult)
3. Level of Care Assessment (LOCUS – Adult Mental Health)
4. Individual treatment plan (ITP)
5. Service delivery; and
6. Reassessment
Clinical Infrastructure Components
Diagnostic Assessment
A diagnostic assessment is a written evaluation, conducted by a mental health professional that includes
different criteria as defined in Outpatient Mental Health Services under Diagnostic Assessment.

Individual Treatment Plan (ITP)
MHCP only covers services in accordance with the recipient’s ITP, except diagnostic assessments, and in
cases of emergency. The recipient’s ITP must be:
 Based on the information and outcome of the diagnostic assessment
 Involve the recipient in the development, review and revision of the ITP
 Developed by the mental health professional who provides the psychotherapy, no later than the end
    of the first psychotherapy session, or five days, if the recipient is in a adult day treatment program
 Signed by the professional and recipient (including revisions), unless the request is not appropriate to
    the recipient’s mental health status. In the case of a child, the child’s parent, primary caregiver, or
    other authorized person must sign the ITP. If a recipient refuses to sign the ITP or his/her mental
    health status contraindicates the request, the mental health professional must document the
    circumstances in the ITP
 Reviewed at least once every 90 days and, if necessary, revised. Exception: ARMHS allows review at
    least once every 180 days and an individual community support plan (ICSP) to be used instead of an
    ITP if a mental health case manager is involved and with the recipient’s approval. The ICSP must
    include the criteria in MS 256B.0623, subd. 10, 2
Telemedicine Delivery of Mental Health Services
Effective October 1, 2006, MHCP covers delivery of mental health services through telemedicine.
Telemedicine delivers mental health services using two-way interactive video which can:
 Extend limited resources
 Expand the geographical area over which a mental health provider can offer direct service
 Save time and energy without compromising quality
 Allows providers and the recipient greater flexibility and increased access when delivering/receiving
 Allows recipients to receive needed services without having to travel long distances
Eligible Recipients
Recipients are eligible to receive their mental health services via telemedicine when:
 Telemedicine is determined medically appropriate
 Before receiving services via telemedicine, a recipient must provide his/her consent
 Recipients must be present to receive service through the telemedicine method
Eligible Providers
Providers currently authorized to provide mental health services may conduct the same services via
telemedicine, except for the following services:
 Day treatment
 Partial hospitalization programs
 Residential treatment services
 Case Management, face-to-face contact
Providers must:
 Conduct a risk analysis
 Develop a risk management plan
 Employ strategies to minimize vulnerabilities in technological equipment and systems
 Create safe and private accommodations for recipients receiving services by telemedicine
 Ensure procedures are in place to prevent system failures that could lead to a breach in privacy or
    cause exposure of recipient mental health records to unauthorized persons
 Use high quality interactive video and audio communications systems and equipment
 Be prepared administratively, operationally, and technologically
Interactive telemedicine systems must be compliant with HIPAA privacy and security requirements and

Services provided via telemedicine have the same service thresholds and authorization requirements as
services delivered face-to-face.

Bill for mental health services delivered via telemedicine with modifier GT.
MHCP does not reimburse for connection charges, or origination, set-up or site fees.
Child with Emotional Disturbance: A child with an organic disorder of the brain, or a clinically significant
disorder of thought, mood, perception, orientation, memory, or behavior that:
 Is listed in the clinical manual of the ICD-9 CM, code range 290.0 to 302.9 or 306.0 to 316.0 or the
    corresponding code in the DSM-MD, Axes I, II, or III;
 Seriously limits a child’s capacity to function in primary aspects of daily living such as personal
    relations, living arrangements, work, school, and recreation
Emotional disturbance is a general term and intended to reflect all categories of disorder described in the
DSM-MD, as usually first evident in childhood or adolescence.

Clinical supervision: A mental health professional directing and overseeing the work of a mental health
practitioner and accepting full professional responsibility for the practitioner’s actions and decisions.

Individual Community Support Plan (ICSP): A written plan developed by a case manager on the basis
of a diagnostic assessment and functional assessment, identifying specific services needed by an adult
with SPMI to develop independence or improved functioning in daily living, health and medication
management, social.
Individual Treatment Plan (ITP): A written plan developed by a mental health professional or mental
health practitioner of intervention, treatment, and services for a recipient.

Mental Illness: : An organic disorder of the brain or a clinically significant disorder of thought, mood,
perception, orientation, memory, or behavior that is listed in the ICD-9 CM, code range 290.0 to 302.9 or
306.0 to 316.0.

Psychotherapy Session: A planned and structured face-to-face treatment episode between the provider
of psychotherapy and one or more individuals. A psychotherapy session may be individual
psychotherapy, family psychotherapy, or group psychotherapy.

Rehabilitative Services: Day treatment, partial hospitalization, ARMHS, CTSS, and crisis response.
Serious and Persistent Mental Illness (SPMI): A condition with a diagnosis of mental illness that meets
at least one of the following:
 The recipient had two or more episodes of inpatient care for mental illness within the past 24 months
 The recipient had continuous psychiatric hospitalization or residential treatment exceeding six months
     duration within the preceding 12 months
 The recipient has been treated by a crisis team two or more times within the preceding 24 months
 The recipient has a diagnosis of schizophrenia, bipolar disorder, major depression or borderline
     personality disorder, evidences a significant impairment in functioning, and has a written opinion from
     a mental health professional stating he/she is likely to have future episodes requiring inpatient or
     residential treatment unless community support program services are provided
 The recipient has, in the last three years, been committed by a court as a mentally ill person under
     Minnesota statutes, or the adult’s commitment as a mentally ill person has been stayed or continued
 The recipient was eligible under one of the above criteria, but the specified time period has expired
 The recipient was eligible as a child with severe emotional disturbance, and the recipient has a
     written opinion from a mental health professional, in the last three years, stating that he/she is
     reasonably likely to have future episodes requiring inpatient or residential treatment of a frequency
     described in the above criteria, unless ongoing case management or community support services are
Severe Emotional Disturbance (SED): When a child with emotional disturbance:
 Has been admitted to inpatient/residential treatment within the last three years or is at risk of being
 Is a MN resident and receiving inpatient treatment or residential treatment for an emotional
     disturbance through the interstate compact
 Has been determined by a mental health professional to meet one of the following criteria:
 Have psychosis or clinical depression
 Be at risk of harming self or others as a result of emotional disturbance
 Has psychopathological symptoms as a result of being a victim of physical/sexual abuse or psychic
     trauma within the past year
 Has a significantly impaired home, school or community functioning lasting at least one year or
     presents a risk of lasting at least one year, as a result of emotional disturbance, as determined by a
     mental health professional.
Eligible Mental Health Providers
Mental health providers include agencies and individuals (professionals and practitioners). Each mental
health agency must have at least one mental health professional on staff. Providers may be eligible to
enroll as MHCP providers (mental health professionals) or may be eligible to provide services but not
eligible to enroll as MHCP providers.

When qualified state staff provides adult mental health services, they are considered part of the certified
local provider entity and their services may be billed in accordance with typical billing practices as
appropriate to the specific service.
Enrollable Mental Health Agencies
   Adult Day Treatment
   Billing Entity for Mental Health
   County-contracted Mental Health Rehabilitation Service
   Community Mental Health Center (CMHC)
   County Human Service Agency
   Indian Health Service (IHS)
   Outpatient hospital
   Physician-directed clinic
   School district
Enrollable Mental Health Professionals
   Clinical Nurse Specialist (CNS)
   Licensed Independent Clinical Social Worker (LICSW)
   Licensed Marriage and Family Therapist (LMFT)
   Licensed Professional Clinical Counselor (LPCC)
   Licensed Psychological Practitioner (LPP)
   Licensed Psychologist (LP)
   Mental Health Rehabilitative Professional
   Psychiatric Nurse Practitioner (NP)
   Psychiatrist
Non-Enrollable Mental Health Providers
 ARMHS Mental Health Rehabilitation Worker
 Certified Peer Specialist
 Mental Health Behavioral Aide
 Mental health practitioners
 Mental Health Targeted Case Manager/Case Manager Associate
Who Can Do Mental Health Diagnostic Assessments and Psychotherapy?
Select mental health practitioners may provide specific mental health services under limited conditions.
Click on this link to view the table, ‘Who Can Do Mental Health Diagnostic Assessments And
General Clinical Supervision Requirements
Clinical supervision is the process of control and direction of a recipient’s mental health services by which
a mental health professional who is a provider accepts full professional responsibility for the supervisee’s
actions and decisions, instructs the supervisee in the supervisee’s work, and oversees or directs the work
of the supervisee.

MHCP has more than one mental health clinical supervision standard. The following standards apply to
all mental health services except: Adult Day Treatment, Adult Crisis Response, ARMHS, ACT, IRTS,
CTSS (excluding Children’s Day Treatment), and MH-TCM. Refer to the specific covered services
sections for supervision requirements.

Mental Health Practitioners General/Specialty Specific Clinical Supervision Requirements chart.

Provider Type Home Page Links
Review related Web pages for the latest news and additions, forms, and quick links.
 Case Management
 Chemical Dependency & Tribal Human Services
 Children’s Residential Treatment
 Clinic/Physician & Physician/Clinic
 Clinical Nurse Specialist
 County Contracted Mental Health Rehab Svcs
 County Human Services Agency
 Day Treatment
 Fed. Qual. Health Center (FQHC)
 Hospital
 Indian Health Service/Facility & Tribal Social Services
 Intensive Residential Treatment Svcs
 Lic. Ind. Clinical Social Worker (LICSW)
 Lic. Marriage & Family Therapist (LMFT)
 Managed Care & Prepaid Health Plan
 Mental Health
 Psychologist
 Regional Treatment Center
 Rural Health Clinic (RHC)
Eligible Recipients
All MHCP recipients are eligible to receive mental health services.
A resident of an Institution for Mental Disease (IMD) is eligible to receive MA services only if the recipient
is receiving inpatient psychiatric care in a JCAHO accredited psychiatric facility and meets one of the
following criteria:
 Is under age 21 years
 Is age 21 years but less than 22 years and has been receiving inpatient psychiatric care in the IMD
     continuously since the resident’s 21 birthday
 Is at least age 65 years
Recipients age 21 years and older but under age 65 years and residing in an IMD must receive their
mental health services through the IMD. A recipient discharged from the IMD may become eligible for
mental health services if eligibility criteria are met. The recipient, if discharged within 180 days is eligible
to receive case management services through Relocation Service Coordination (RSC). Contact the
managed care organization if the recipient is receiving services through the managed care organization.

Refer to the RSC-TCM section for Relocation Services Coordination and Targeted Case Management
Non-covered Services
The following are not covered MHCP mental health services:
 Mental health services provided by a non-psychiatrist, except psychological testing, to a recipient who
   is inpatient and has a mental illness diagnosis (these services are included in the hospital’s payment)
 Mileage (provider travel time is not the same as mileage)
 Transporting a recipient, except for case managers
 Telephone calls
 Written communication between provider and recipient
 Reporting, charting and record keeping
 Community planning or consultation, program consultation/monitoring/evaluation, public information,
   training and education activities, resource development, and training activities
 Fund-raising
 Court-ordered services for legal purposes
 Mental health service not related to the recipient’s diagnosis or treatment for mental illness
 Services dealing with external, social, or environmental factors not directly addressing the recipient’s
   physical or mental health
 Staff training
 Case management services provided to GAMC recipients
 Mental health case management for recipients receiving similar services through the Veterans
   Administration (VA)
 Duplicate services (for example, mental health case management for recipients receiving case
   management services through a home and community-based services)
  Mental health services provided by a school or local education agency, unless the school or agency is
   an MHCP enrolled provider and the services are medically necessary and prescribed in the child’s
 Mental health services provided by an entity whose purpose is not health service related (for
   example, services provided by the Division of Vocational Rehabilitation or Jobs and Training);
 Legal services, including legal advocacy, for the recipient
 Information and referral services included in the county’s community social service plan
 Outreach services through the community support services program
 Assistance in locating respite care, special needs day care, and assistance in obtaining financial
   resources, except when these services are provided as part of case management
 Client outreach
 Recreational services, including sports activities, exercise groups, craft hours, leisure time, social
   hours, meal or snack times, trips to community activities, etc.
Right to Appeal Denial of Certification or County Contract
Providers required to be certified by or contracted with a county, as part of the criteria to become an
authorized provider of mental health services under Medicaid rules, may appeal a county refusal to grant
the necessary contract or certification, to the commissioner. A recipient may initiate an appeal on behalf
of a provider denied certification. A request for a review of the county decision may be sent/faxed to the
Adult or Children’s Mental Health Division at either:

DHS Mental Health Division – Appeal Review
P.O. Box 64981
444 Lafayette Rd.
St. Paul, MN 55164-0981

For adults fax to: 651-431-7418 (Attention: Mental Health Appeal Review)
For children fax to: 651-431-2321 (Attention: Mental Health Appeal Review)
Legal References
MS 245.461 to 245.486 and MS 245.487 to 245.488: Minnesota Comprehensive Mental Health Acts
MS 245.62, 256B.0625, subd. 5 and Minnesota Rules 9520.0750 to 9520.0870: CMHC
MS 148.88 to 148.98: LP licensure requirements
MS 148.908: LPP licensure requirements
MS 148.925, subd.7: Board of Psychology variance for LPP supervision requirements
MS 148D.055, subd. 5: LICSW licensure requirements|
MS 147: Psychiatrist licensure requirements
MS 148.171 to 148.285: Clinical Nurse Specialist licensure requirements
MS 148B.29 to 148B.39: LMFT licensure requirements
MS 148.171 to 148.285: NP licensure requirements
MS 256B.0623, subd. 10 (2): ICSP
MS 245.461 to 245.486
MS 245.487 to 245.4887
MS 245.50 to 245.52; 245.61 to 245.66; 245.697; 245.699; 245.70; 245.71; 245.715
MS 256B.04
MS 256B.0623; 256B.0624; 256B.0625; 256B.0945; 256B.761; 256B.81; 256B.82; 256B.83; 256B.84;
256D.03; 256L.03
MS 256B.0943 (CTSS)
MS 256B.0615 Certified Peer Specialist Support Services
MS 256B.0625, subd. 46 (Telemedicine)
MS 256B.81 (Mental health provider appeal process)
MS 260 to 260.191
Minnesota Rules, 9505.2175 (Table of contents for Chapter 9505 Health Service Records)
Minnesota Rules, 9505.0322 to 9505.0475
Minnesota Rules, 9505.0322 to 9505.0327 (Rule 47, MH services portion)
Minnesota Rules, 9505.0540
Minnesota Rules, 9505.5000 to 9505.5105
Minnesota Rules, 9505.2175 to 9505.2180
Minnesota Rules, 9505.0500 to 9505.0670 (Rule 36)
Minnesota Rules, 9520.0750 to 9520.0870 (Rule 29)
Minnesota Rules, 9520.0900 to 9520.0926 (Rule 79)
Minnesota Rules, 9535.4068 (Rule 15)
Minnesota Rules, 9545.0905 to 9545.1090 (Child Caring Institutions)
42 CFR 435.1008-1009 (IMD)
42 CFR 440.60(a)
42 CFR 440.160 (inpatient psych, under 21)
42 CFR 440.170(e) (emergency hospital services)
42 CFR 440.230 (amount, scope, and duration)
Title XIX, Section 1915(g) of the Social Security Act (MH-TCM)

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