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.
The goals of behavioral health home services are that an individual:
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.
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 webpage.
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:
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:
Assessments must be performed in accordance with requirements outlined in the MHCP Provider Manual Diagnostic Assessment section.
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).
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.
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.
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.
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.
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.
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 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.
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:
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:
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. See BHH MCO Contact Information.
Behavioral health home services are designed to help connect people to medically appropriate services, and to help people remove barriers that keep them from effectively engaging with medically necessary services. Unless a service has been specifically identified as a duplicative service (see Noncovered Services section), it is permissible for a BHH provider to bill for other MA covered services delivered to a person who is also receiving BHH services. The BHH services rate was developed as a per member, per month payment to allow the provider flexibility to provide the right service, at the right time, based on the person’s needs and circumstances.
Behavioral health home provider “A” is also certified to provide ARMHS. A person receiving BHH services has been determined to be eligible for ARMHS. The BHH services provider organization is permitted to bill for both services as long as the provider organization has met the billing requirements for each service.
Behavioral health home provider “B” is also a primary care services provider. A person receiving BHH services has been determined to be in need of asthma education. The BHH provider organization is permitted to bill for both services as long as the provider organization has met the billing requirements for each service.
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:
Billing information for procedure codes S0280 and S0281:
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.
BHH services ongoing standard care
maintenance of plan
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:
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.
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.
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.
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