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Behavioral Health Home Services

Revised: 03-02-2017

Overview

The term “behavioral health home” services refers to a model of care focused on integration of primary care, mental health services, and social services and supports for adults diagnosed with mental illness or children diagnosed with emotional disturbance. The behavioral health home (BHH) services model of care utilizes a multidisciplinary team to deliver person-centered services designed to support a person in coordinating care and services while reaching his or her health and wellness goals.

Goals of Behavioral Health Home Services

The goals of behavioral health home services are that an individual:

  • • Has access to and utilizes routine and preventative health care services
  • • Has consistent treatment of mental health and other co-occurring health conditions
  • • Gains knowledge of health conditions, effective treatments and practices of self-management of health conditions
  • • Learns and considers healthy lifestyle routines
  • • Has access to and uses social and community supports to assist the individual meet his or her health wellness goals
  • Eligible Providers

    To provide behavioral health home services, a clinic or agency must be enrolled as a Minnesota Health Care Programs (MHCP) provider and must successfully complete the MHCP certification process.

    Certification Process

    To be certified to deliver behavioral health home services, an agency must demonstrate that all locations from which behavioral health home services will be provided are MHCP enrolled, and that all behavioral health home service teams operated by the agency or entity meet the behavioral health home services certification standards outlined in DHS-6766-ENG. The behavioral health home certification process consists of an online application and a site visit. Detailed information about certification requirements and standards are available on the Department of Human Services provider certification web page.

    Eligible Recipients

    To be eligible for behavioral health home services a person must be eligible for Medical Assistance (MA) coverage and have a condition that meets the definition of serious mental illness as defined in Minnesota Statutes, section 245.462, subdivision 20, paragraph (a), or emotional disturbance as defined in Minnesota Statutes, section 245.4871, subdivision 15, clause (2), and has a current diagnostic assessment (DA) as defined in Minnesota Rules, part 9505.0372, subpart 1, item B or C. The diagnostic codes list can be found in the provider manual.

    Certified BHH services providers must ensure that the following elements are complete prior to determining eligibility for BHH services:

  • • The BHH services provider confirms that the member has current MA coverage.
  • • The BHH services provider reviews and explains the Behavioral Health Home (BHH) Services Rights, Responsibilities and Consent form (DHS-4797B-ENG) (PDF) to the person. If the person is receiving a duplicative service, the person must decide which service he or she wants to receive. If the person chooses to receive BHH services, the person must sign the DHS-4797B form. The BHH services provider should give the person a copy of the form for his or her records.
  • • A mental health professional (MHP) employed by or under contract with the BHH services provider must perform or review a diagnostic assessment appropriate to the person’s age and symptoms to determine if the member meets the eligibility criteria for BHH services. See the MHCP Provider Manual Diagnostic Assessment section for more information. If the member does not have a current diagnostic assessment, the BHH provider is responsible for supporting the member in obtaining a diagnostic assessment.
  • Intake for BHH services is considered complete as of the date that all of the above elements have been completed.
  • Diagnostic Assessments

    Minnesota Statutes, section 256B.0757, subd. 4 specifes that eligibility for BHH services must be determined based on a diagnostic assessment (DA) as defined in Minnesota Rules, part 9505.0372, subpart 1, item B or C. The DA must be performed or reviewed by a mental health professional employed by or under contract with the behavioral health home provider.

    For purposes of eligibility for BHH services, one of the following types of diagnostic assessment is allowable:

  • • Standard diagnostic assessment
  • • Extended diagnostic assessment
  • • Adult diagnostic assessment update
  • Assessments must be performed in accordance with requirements outlined in the MHCP Provider Manual Diagnostic Assessment section.

    Covered Services

    BHH services providers must have the capacity to deliver the following six core services based on the individual’s needs and in accordance with the BHH Certification Standards (DHS-6766-ENG) (PDF).

    1. Care Management

    Comprehensive care management is a collaborative process designed to manage medical, social and behavioral health conditions more effectively based on population health data and tailored to the person.

    2. Care Coordination

    Care coordination occurs when the BHH services team acts as the central point of contact in the compilation, implementation and monitoring of the individualized health action plan through appropriate linkages, referrals, coordination and follow-up to needed services and supports. Specific care coordination activities are conducted with people and their identified supports, medical, behavioral health and community providers, and across and between care settings.

    3. Health and Wellness

    Health and wellness promotion services encourage and support healthy living and motivate people and their identified supports to adopt healthy behaviors and promote better management of their health and wellness. The providers place a strong emphasis on skills development so individuals and their identified supports can monitor and manage their chronic health conditions to improve health outcomes.

    4. Comprehensive Transitional Care

    Comprehensive transitional care activities are specialized care coordination services that focus on the movement of people between different levels of care or settings. Transition services are designed to streamline plans of care and crisis management plans, reduce barriers to timely access, reduce inappropriate hospital, residential treatment, and nursing home admissions, interrupt patterns of frequent emergency department use, and prevent gaps in services which could result in (re)admission to a higher level of care or longer lengths of stay at an unnecessary level of care.

    5. Individual and Family Supports

    Individual and family support services are activities, materials or services aimed to help people reduce barriers to achieving goals, increase health literacy and knowledge about chronic condition(s), increase self-efficacy skills, and improve health outcomes.

    6. Referral to Community Supports

    Referral to community and social support services are activities that ensure people have access to resources to address their identified goals and needs. Resources should address social, environmental and community factors. These factors impact holistic health, including but not limited to, medical and behavioral health care, entitlements and benefits, respite, housing, transportation, legal services, educational, employment services and financial. The BHH services team will close the loop on all referrals to ensure people are supported in achieving their goals.

    Service Delivery Requirements

    Service delivery requirements are listed in section six of the BHH certification standards (DHS-6766-ENG) (PDF). Adherence to the service delivery requirements will be monitored as part of the recertification process.

    Initial Engagement and Assessment

    BHH services providers must meet and deliver initial engagement and assessment services that meet the requirements of BHH certification standard 6E (DHS-6766) (PDF). During the initial 90-day engagement period, a member of the BHH team must meet with the person face-to-face to:

  • • Complete the intake process and the brief needs assessment and develop a plan to address immediate needs as appropriate
  • • Complete the initial health wellness assessment within 60 days after intake
  • • Develop the health action plan within 90 days after intake
  • Face-to-Face Requirements

    A member of the BHH services team must meet face-to-face with the person every 60 days. This meeting must be linked to the person’s goals and can be attended by any BHH services team member. The face-to-face contact requirement can be met by any of the following activities:

  • • Meeting face-to-face with the person to complete the six-month review of the health action plan
  • • Accompanying a person to an appointment
  • • Providing face-to-face individual or group health education or support services
  • • Meeting face-to-face with the person to support their goals
  • For children, the BHH services team can meet the face-to-face requirement by meeting with the child’s parent or legal guardian. For transition age youth, the BHH team can meet the face-to-face requirements by meeting with the youth or the youth’s identified supports (or both).

    With the exception of the face-to-face requirements for completing and updating the intake, brief needs assessment, initial health wellness assessment and health action plan, the BHH services team may meet the face-to-face requirement by using two-way interactive video or store-and-forward technology.

    BHH services providers must update a person’s health action plan at least every six months.

    Noncovered Services

    Individuals eligible for behavioral health home services are eligible for all MA-covered services. However, payment for duplicative services in the same calendar month is prohibited. The person must choose which available MA-covered service best meets his or her needs.

    The following services are considered duplicative of behavioral health home services:

  • • Adult mental health targeted case management (AMH-TCM)
  • • Children’s mental health targeted case management (CMH-TCM)
  • • Assertive community treatment (ACT)
  • • Vulnerable adult/developmental disability targeted case management (VA/DD-TCM)
  • • Relocation services coordination targeted case management (RSC-TCM)
  • • Health care home (HCH) care coordination services
  • For people who have fee-for-service MA coverage, MHCP will pay on the first claim submitted in a calendar month for any one of the duplicative services. Subsequent claims in the same calendar month for one of the identified duplicate services will not be paid. Medicaid managed care organizations (MCO) are also prohibited from payment of duplicative services in the same calendar month. However, MCOs may develop different mechanisms to avoid duplicate payments, such as a take-back of payment following a reconciliation of monthly claims, or denial of a subsequent duplicate claim in the same calendar month. Providers should contact the MCO directly to learn what procedures the MCO will use to ensure no duplicate payment. BHH MCO Contact Information

    Billing

    The rate for behavioral health home services is a per member per month payment. Certified behavioral health home services providers are required to carry out a service eligibility determination prior to billing for behavioral health home services.

    To receive payment for delivery of behavioral health home services, certified providers must:

  • • Have personal contact with the person or the identified support at least once per month
  • • The contact must be connected to at least one of the six required services linked to the person’s goals in the health action plan
  • • Personal contact may include face-to-face, telephone contact or interactive video. A letter, voicemail or text alone does not meet the requirement for monthly personal contact
  • Billing information for procedure codes S0280 and S0281:

    Proc

    Mod

    Service

    Unit

    Limitations

    S0280

    U5

    BHH services care engagement, initial plan

    Per member per month (pmpm)

    Lifetime limit of six payments in enrollee’s lifetime.

    No payment if prior payment for duplicative service was made in same calendar month.

    S0281

    U5

    BHH services ongoing standard care

    maintenance of plan

    pmpm

    No payment if prior payment for duplicative service was made in the same calendar month.


    An individual may receive no more than six payments at the enhanced rate per member per month. Providers should track the number of times S0280 U5 has been claimed. If a person is covered on a fee-for-service basis, any claim for the enhanced payment beyond the allowed six will automatically be denied and converted to the base rate. For people enrolled in an MCO, the process for tracking the enhanced payment will require the MCO to review a monthly report produced by DHS to see how many times a provider has billed at the enhanced rate (including payments made by the MCO, another MCO, or fee-for-service). The MCO is responsible for taking back any enhanced payment that exceeds the lifetime six month payment limit.

    Additional billing information:

  • • The initial plan code (S0280 U5) can be billed at any time and no break is required to bill for the six maximum lifetime services: i.e., code S0280 U5 can be billed for the months of January-June or January, February and November
  • • Code S0281 U5 (maintenance plan) does require that code S0280 U5 (initial plan) be submitted prior to the S0281 U5 submission
  • • Code S0280 U5 cannot be submitted in the same month as S0281 U5
  • • To receive payment, the claim for BHH services must use the NPI and address listed on the organization’s BHH services certification approval letter
  • Treating Provider
    For individuals who have fee-for-service MA coverage, most BHH services providers are not required to identify a treating provider. BHH services providers that bill using a billing entity must identify a treating provider . The treating provider must be affiliated with the billing entity and is required to be the integration specialist.

    For individuals who are enrolled in an MCO, BHH services providers will need to contact the individual’s MCO to determine what the MCO requires on the claim for BHH services. See the BHH MCO Contact Information (PDF) for further information.

    BHH services providers submitting electronic claims should use the 837P.

    BHH services providers should use the diagnostic code(s) that corresponds with the person’s mental health diagnosis that established the person’s eligibility for BHH services.

    Managed Care Recipients

    Notification

    If a person who has been determined eligible for BHH services is enrolled in managed care, the BHH provider must send a copy of the Determination of Eligibility for Behavioral Health Home (BHH) services (DHS-4797-ENG) (PDF) form to the MCO’s designated contact. BHH providers should consult the BHH MCO Contact Information (PDF) to obtain the appropriate contact information for the MCO.

    Communication and Coordination

    BHH services providers are required to communicate and coordinate with MCOs to ensure that services and activities are coordinated to most effectively meet the goals of the person and to ensure that duplication between the MCO and the BHH services provider is avoided. BHH providers and MCOs must adhere to the communication and coordination protocols established in BHH MCO Roles and Responsibilities worksheet. An MCO and a BHH services provider can choose to add requirements for communication or coordination to the BHH Services MCO Roles and Responsibilities worksheet by mutual agreement. If the MCO and the BHH services provider agree to make additions to the worksheet, the MCO and the BHH provider must provide a copy of the updated worksheet and signatures from responsible staff at the MCO and the BHH provider to demonstrate that both entities have agreed to the additional terms specified in the updated worksheet.

    Legal References

    42 U.S.C. 1396w-4
    Minnesota Statutes 256B.0757
    Minnesota Statutes 245.461 to 245.468, Minnesota Comprehensive Adult Mental Health Act
    Minnesota Statutes 245.462, Definitions
    Minnesota Statutes 256B.0625, subd. 20, Mental Health Case Management
    Minnesota Statutes 245.462, subdivision 20, paragraph (a)
    Minnesota Statutes 245.4871, subdivision 15, clause (2)
    Minnesota Rules, part 9505.0372, subpart 1, item B or C

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