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Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

Revised: 10-23-2017

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • CCBHC Covered Services
  • Noncovered Services
  • Billing Expanded CCBHC Covered Services
  • Additional CCBHC Billing and Payment Provisions
  • Legal References
  • Overview

    CCBHC is a federal demonstration project that is measuring how an integrated community clinic model of care can improve service quality and accessibility. CCBHCs:

  • • Provide integrated, evidence-based, trauma informed, recovery-oriented and person-and family-centered care
  • • Offer the full array of CCBHC-required mental health, substance-use disorder (SUD) and primary care screening services
  • • Have established collaborative relationships with other providers and healthcare systems to ensure coordination of care
  • Effective dates for this federal demonstration are from July 1, 2017, through June 30, 2019.

    Eligible Providers

    Eligible CCBHC providers are limited to the six organizations certified to participate in the CCBHC federal demonstration. Participating CCBHCs are enrolled MHCP service providers for all CCBHC services and have been certified as meeting the required federal criteria and state standards.

    CCBHC providers certified to participate in this demonstration are:

  • • Northwestern Mental Health Center
  • • Northern Pines Mental Health Center
  • • People Incorporated
  • • Ramsey County Mental Health Center
  • • Wilder Mental Health and Wellness
  • • Zumbro Valley Health Center
  • Eligible Recipients

    MHCP eligible recipients must meet the following criteria to be a CCBHC recipient:

  • • For new recipients (those not served by the clinic in the six months prior to the current service):
  • • Receive a preliminary screening and risk assessment and one CCBHC service, or
  • • Receive a crisis assessment
  • • Existing recipients (those served in any CCBHC in the six months prior to service) are eligible upon receipt of a CCBHC service after July 1, 2017
  • CCBHC Covered Services

    Covered CCBHC services include:

    Existing MHCP services billed in accordance with existing MHCP requirements:

  • Adult crisis response services
  • Adult day treatment
  • Adult rehabilitative mental health services (ARMHS)
  • Alcohol and drug abuse services
  • Certified peer specialist services
  • Children’s mental health crisis response services
  • Children’s therapeutic services and supports (CTSS)
  • Diagnostic assessment
  • Dialectical behavior therapy (DBT)
  • Mental health family peer specialist
  • Mental health provider travel time
  • Mental health targeted case management for adults (AMH-TCM)
  • Mental health targeted case management for children (MH-TCM)
  • Neuropsychological services
  • Psychiatric consultation to primary care providers
  • Psychological testing
  • Psychotherapy
  • Psychotherapy for crisis
  • Expanded MHCP services only for CCBHC providers:

  • Preliminary screening and risk assessment
  • Initial evaluation
  • Comprehensive evaluation
  • Integrated treatment plan
  • Clinical care consultation
  • Family psychoeducation
  • Functional Assessment and Level of Care Determination
  • Certified peer recovery specialist
  • Comprehensive substance use disorder assessment
  • Care coordination
  • Please see the CCBHC rate schedule for the CCBHC expanded service reimbursement rates.

    ASAM 6 Dimensions

    Providers must write the initial evaluation, comprehensive evaluation and the integrated treatment plan in the format of the ASAM 6 Dimensions, outlined below:

  • • Dimension 1: Acute intoxication or withdrawal potential
  • • Dimension 2: Biomedical conditions and complications
  • • Dimension 3: Emotional, behavioral and cognitive
  • • Dimension 4: Readiness for change
  • • Dimension 5: Relapse, continued use and continued problem potential
  • • Dimension 6: Recovery environment
  • Initial Evaluation

    The initial evaluation must:

  • • Include the reason the recipient is presenting for assistance, a preliminary diagnosis, make referrals to services within the CCBHC (specifically: outpatient SUD services, ARMHS, TCM, CTSS, peer services and psychotherapy) and establish medical necessity for those services
  • • Be administered to any new recipient age five and older
  • • Include a face-to-face interview with the recipient and written evaluation done by a mental health professional or practitioner working under a licensed professional as a clinical trainee
  • • A Licensed Alcohol and Drug Abuse Counselor (LADC) may assess an individual’s substance use and determination of medical necessity for SUD treatment. Include assessment results within the Initial Evaluation
  • Required Assessment Components:

  • • Date of birth
  • • Gender
  • • Ethnicity
  • • Race
  • • Insurance status and type
  • • Primary language
  • • Current living situation
  • • A determination of whether the person presently is or ever has been a member of the U.S. Armed Services
  • • Referral source
  • • Reason for seeking care, as stated by the recipient or other individuals who are significantly involved
  • • A drug profile including the person’s prescriptions, over-the-counter medications, herbal remedies and other treatments or substances that could affect drug therapy, as well as information on drug allergies
  • • Assessment of recipient risk to self or to others, including suicide risk factors and other immediate health and safety concerns
  • • Assessment of need for medical care with referral and follow-up as required
  • • Screening for co-occurring mental health and substance use disorders using a tool approved by the commissioner
  • • Brief narrative within each of the 6 dimensions of the ASAM criteria addressing:
  • • All reasons for seeking care
  • • Strengths, cultural influences, life situations, learning differences and legal issues
  • • The narrative for dimension 3 must include a brief diagnostic discussion including symptoms, duration, preliminary diagnoses and how symptoms impact the person’s functioning
  • • Identification of the person’s immediate clinical care needs for mental and substance use disorders related to the diagnoses and impact on functioning including:
  • • Recommendations for identified mental health and substance use disorder services (specifically: SUD services, ARMHS, TCM, CTSS, peer services and psychotherapy)
  • • Determination of medical necessity for those services. For substance use disorder services, utilization of the Minnesota Matrix (DHS-5204B) (PDF) to provide scores on the 6 Dimensions and the diagnosis of a substance use disorder is required only for those for whom substance use is identified
  • • Documentation of next steps for service initiation that may include recipient-defined initial goals, short-term objectives and suggested interventions, including need for further assessment
  • It is allowable for CCBHC providers to gather required initial evaluation information from internal staff, existing documentation, and other providers that the CCBHC has obtained a release of information from, if the documentation is less than one year old.

    Comprehensive Evaluation

    The comprehensive evaluation includes a review and synthesis of existing information obtained from external sources, internal staff, preliminary screening and risk assessment, crisis assessment, initial evaluation or other service received at the CCBHC.

    The comprehensive evaluation:

  • • Must include a face-to-face interview with the recipient and written evaluation done by a mental health professional or practitioner working under a licensed professional as a clinical trainee
  • • A new comprehensive evaluation or update is completed in accordance with timeframes established for completion of a new or updated diagnostic assessment within existing service standards (e.g. annually for children receiving CTSS, every three years for an adult receiving TCM services)
  • • For existing CCBHC recipients, the comprehensive evaluation must be completed when the current diagnostic assessment expires
  • Assessment Components
    The comprehensive evaluation must include the following components:

  • • Updates to all required components of the initial evaluation
  • • A psychosocial evaluation including housing, vocational and educational status, family or caregiver and social support, pregnancy and parenting status, legal issues and insurance status (A functional assessment (FA) completed within the previous 60 days satisfies this requirement)
  • • It is allowable, but not required to complete the WHODAS
  • • For children age 5-18 years old, complete the Strengths and Difficulties Questionnaire (SDQ) if not already completed within an FA
  • • Behavioral health (including mental health, chemical health and physical health) history (including trauma history and previous therapeutic interventions and hospitalizations)
  • • Assessment of imminent risk (including suicide risk, danger to self or others, substance withdrawal, urgent or critical medical conditions, other immediate risks including threats from another person)
  • • Depression screening tool
  • • Basic competency or cognitive impairment screening (including the person’s ability to understand and participate in his or her own care)
  • • Developmental incidents and history
  • • A description of attitudes and behaviors, including cultural and environmental factors, that may affect the person’s treatment plan
  • • The recipient’s strengths, goals and other factors to be considered in recovery planning
  • • Depending on whether the CCBHC directly provides primary care screening and monitoring of key health indicators and health risk, either: (a) an assessment of need for a physical exam or further evaluation by appropriate health care professionals, including the person’s primary care provider (with appropriate referral and follow-up), or (b) a basic physical assessment
  • • Brief narrative within each of the 6 dimensions of the ASAM criteria addressing:
  • • All reasons for seeking care
  • • Progress since last evaluation
  • • Remaining barriers that will lead to formation of the treatment plan
  • • Strengths, cultural influences, life situations, learning differences and legal issues
  • • The narrative for ASAM dimension 3 must include a mental status exam and a brief diagnostic discussion including symptoms, duration, preliminary diagnoses and how symptoms impact the person’s functioning
  • • The narrative for ASAM dimension 4 must identify the stage of change for all reasons the recipient sought care
  • • Establish medical necessity for services and level of care (LOC) needs for recommended services (approved LOC tools: LOCUS for adults, CASII for children and adolescents, and ECSII for children up to five years old)
  • • Assessment of need and medical necessity for behavioral health services beyond what is already provided including:
  • • For substance use disorder services, utilization of the Minnesota Matrix to provide scores on the 6 Dimensions and the diagnosis of a substance use disorder
  • • Assessment of the social service needs of the consumer with necessary referrals made to social services and, for pediatric consumers, to child welfare agencies as appropriate
  • Comprehensive evaluation for children under five years old must utilize the DC:0-5R diagnostic system for young children which must be composed of three separate billable encounters which include:

  • • An initial session as a family psychotherapy session without the client present and may include providing treatment to the parent(s) or guardian(s) along with inquiring about the child. Bill the initial session as a family psychotherapy session (90846). If possible, defer billing until completion of assessment with encounter date as date of service.
  • • Three separate sessions must follow the initial session; one session must include face-to-face contact with the child.
  • • Bill the three completed assessment sessions as an extended comprehensive evaluation (90791 TG Q2).
  • • The functional assessment and level of care tools must be incorporated into the comprehensive evaluation for it to be considered complete.
  • • The functional assessment and level of care tool is separately billable (H0031) provided it meets standards outlined in the Functional Assessment 0-5 section of this manual page.
  • • The extended comprehensive assessment and functional assessment must be completed prior to recommending additional CCBHC services.
  • • In the event patient or family participation stops before all sessions are completed, CCBHCs may bill for the sessions completed.
  • It is allowable for CCBHC providers to gather information for each required assessment component from internal staff, existing documentation or other providers from whom the CCBHC has obtained a release of information and if the documentation is less than one year old.

    Integrated Treatment Plan

    The integrated treatment plan (ITP) is the result of a person and family-centered planning process in which the recipient, any family or recipient-defined natural supports, CCBHC service providers, external service providers as appropriate, and care coordination staff are engaged in creation of the integrated treatment plan. ITP development should include the recipient and all interested parties; however, at minimum, the ITP must be completed in a face-to-face interaction with the recipient; and be reviewed and signed by a qualified mental health professional or by a mental health practitioner working as a clinical trainee.

    CCBHCs must complete the ITP within 60 days of first contact for new recipients.

    Integrated Treatment Plan Components
    The components must be in the format of the 6 dimensions of the ASAM Criteria and must contain the following core elements:

  • • Recipient-defined vision
  • • Identified problems or functional barriers
  • • Measurable goals toward obtaining the recipient-defined vision
  • • Measurable objectives toward reaching the goals
  • • Interventions
  • • Strengths and resources that inform the objectives
  • • Cultural considerations
  • • Timeline (frequency and duration)
  • • Signatures of the mental health professional and the person with dates
  • • For a child, the signature of a parent or guardian or other adult authorized by law to provide consent for treatment
  • • A client’s parent or guardian may approve the integrated treatment plan by secure electronic signature or by documented oral approval that is later verified by written signature
  • • In instances where oral approval is verified by a later written signature, the effective date is the date of oral approval, which is documented in the integrated treatment plan
  • The integrated treatment plan incorporates information gathered about and by the recipient including the initial evaluation, comprehensive evaluation and any progress made in all utilized services and:

  • • Documentation of recipient involvement in plan development
  • • Documentation of parental or guardian consent for those under 18 years old or under legal guardianship
  • Integrated Treatment Plan Update
    Providers must update the ITP at least every 90 days and anytime there is significant change in the recipients’ situation, functioning, service methods or at the request of the recipient or the recipient’s legal guardian. ITP updates require the recipient be present and engagement of any recipient-defined natural supports, CCBHC service providers, external service providers as appropriate and care coordination staff.

    The ITP update must incorporate the following components:

  • • A review of the previous comprehensive evaluation, progress notes and information gathered since the last comprehensive evaluation
  • • A review of the previous integrated treatment plan, progress notes and information gathered since the last integrated treatment plan
  • • Brief summary of progress made and barriers that remain
  • • Diagnostic updates based on any changes, as needed
  • • Assessment of need for behavioral health services beyond what is already provided
  • • Treatment plan updates including goal achievement and identification of new goals and objectives
  • • Status updates:
  • • Whether recipient received some peer service as of date of update
  • • Whether recipient received some telemedicine service as of date of update
  • • Type of health insurance
  • • Housing or residential status
  • Clinical Care Consultation

    Clinical care consultation is a covered demonstration service for adult MHCP recipients (21 years old and over). CCBHC providers should refer to the MHCP Provider Manual for Children’s Mental Health Clinical Care Consultation for a definition of the covered service.

    Family Psychoeducation

    Family psychoeducation is a covered demonstration service for adult MHCP recipients (21 years old and over). CCBHC providers should refer to the MHCP Provider Manual for Family Psychoeducation for a definition of the covered service.

    Functional Assessment and Level of Care Determination

    Functional assessment and the level of care determination is a covered demonstration service for all CCBHC recipients regardless of services rendered. Administer functional assessment and level of care determination instruments according to established service and instrument schedules.

    For Children up to Six Years Old

    CCBHC providers may bill the level of care determination portion of the diagnostic process for young children as an additional encounter separate from the multi-session comprehensive evaluation. In order to be separately reimbursable, the level of care determination must:

  • • Utilize the Early Childhood Service Intensity Instrument (ECSII)
  • • Utilize the Child Behavior Checklist (CBCL)
  • • Be scored and interpreted by a mental health professional or practitioner working as a clinical trainee
  • For Children Six through 17 Years Old

    CCBHC providers may bill the level of care determination portion of the diagnostic process for children six through 17 years old, as an additional encounter separate from the comprehensive evaluation. In order for the level of care determination to be separately reimbursable, the level of care determination must:

  • • Utilize the Child and Adolescent Service Intensity Instrument (CASII)
  • • Utilize the Strengths and Difficulties Questionnaire (SDQ)
  • • Be completed, scored and interpreted by a mental health professional or practitioner working as a clinical trainee Practitioner level staff may assist in the collection of information, but a mental health professional must perform the scoring and interpretation
  • For Adults 18 Years Old and Over

    CCBHC providers may bill for the functional assessment and level of care determination completed for any CCBHC recipient age 18 years and over. In order for the functional assessment to be reimbursable as an encounter separate from other assessments the functional assessment must:

  • • Include one of the following functional instruments:
  • • A narrative for each domain as described in the MHCP manual for Functional Assessments
  • • A DLA-20 and a functional summary. The functional summary is a personalized narrative that provides qualitative context to the quantitative information obtained from the DLA-20. The narrative describes how symptoms of mental illness impair functioning, informs the comprehensive evaluation and provides initial direction for the integrated treatment plan
  • • Be completed by a mental health practitioner, a mental health professional or practitioner working under a licensed professional as a clinical trainee
  • Time spent completing a Level of Care Utilization System (LOCUS) assessment and a LOCUS Recording Form (DHS-6249) is allowable yet not required.

    If an FA or LOCUS is required for a specific service line, all service line requirements must be met in addition to the above requirement.

    FA and LOCUS assessments completed as part of targeted case management services cannot be billed as an independent encounter.

    Certified Peer Services

    Mental health certified peer specialist services are covered demonstration services for adult MHCP recipients (18 years old and over) if determined medically necessary by a qualified mental health professional. CCBHC certified peer specialist services are subject to the same standards outlined in the Certified Peer Specialist Services section of the MHCP Provider Manual with the exception of limiting services to rehabilitation and crisis service recipients.

    Mental health certified family peer specialist services are allowable within a CCBHC if determined medically necessary by a qualified mental health professional. CCBHC mental health certified family peer specialist services are subject to the same standards outlined in the Mental Health Certified Family Peer Specialist section of the MHCP Provider Manual.

    Certified peer recovery specialist services are covered demonstration services if determined medically necessary by a licensed professional. Certified peer recovery services must be provided according to the following guidelines:

  • • Have a minimum of one year in recovery from substance use disorder
  • • Hold a current credential from a certification body approved by the commissioner that demonstrates skills and training in the domains of ethics and boundaries, advocacy, mentoring and education, and recovery and wellness support
  • • Receive ongoing supervision in areas specific to the domains of the recovery peer's role by an alcohol and drug counselor or an individual with a certification approved by the commissioner
  • Certified peer recovery specialist services include:
  • • Education
  • • Advocacy
  • • Mentoring through self-disclosure of personal recovery experiences
  • • Attending recovery and other support groups with a client
  • • Accompanying the client to appointments that support recovery
  • • Assistance accessing resources to obtain housing, employment, education and advocacy services
  • • Nonclinical recovery support to assist the transition from treatment into the recovery community
  • Comprehensive Substance Use Disorder (SUD) Assessment

    An alcohol and drug counselor must coordinate a comprehensive assessment of the client's substance use disorder within three sessions of outpatient SUD services. The counselor may rely on current information provided by a referring agency or other sources as a supplement when information is available. Information gathered more than 45 days before the date of admission is not current. The assessment must include sufficient information to complete the assessment summary. The comprehensive assessment must include information about the client's problems that relate to chemical use and personal strengths that support recovery, including:

  • • Age, sex, cultural background, sexual orientation, living situation, economic status and level of education
  • • Circumstances of service initiation
  • • Previous attempts at treatment for chemical use or dependency, compulsive gambling or mental illness
  • • Chemical use history including amounts and types of chemicals used, frequency and duration of use, periods of abstinence, and circumstances of relapse, if any. For each chemical used within the previous 30 days, the information must include the date and time of the most recent use and any previous experience with withdrawal
  • • Specific problem behaviors exhibited by the client when under the influence of chemicals
  • • Current family status, family history, including history or presence of physical or sexual abuse, level of family support, and chemical use, abuse or dependency among family members and significant others
  • • Physical concerns or diagnoses, the severity of the concerns and whether or not the concerns are being addressed by a health care professional
  • • Mental health history and current psychiatric status, including symptoms, disability, current treatment supports and psychotropic medication needed to maintain stability
  • • Arrests and legal interventions related to chemical use
  • • Ability to function appropriately in work and educational settings
  • • Ability to understand written treatment materials, including rules and client rights
  • • Risk-taking behavior, including behavior that puts the client at risk of exposure to blood borne or sexually transmitted diseases
  • • Social network in relation to expected support for recovery and leisure time activities that have been associated with chemical use
  • • Whether the client is pregnant and if so, the health of the unborn child and current involvement in prenatal care
  • • Whether the client recognizes problems related to substance use and is willing to follow treatment recommendations
  • An alcohol and drug counselor must prepare an assessment summary. The narrative summary of the comprehensive assessment results must meet the following requirements:

  • • A risk description according to Minnesota Rule, part 9530.6622, for the ASAM 6 dimensions
  • • Narrative supporting the risk descriptions
  • • A determination of whether the client meets the DSM criteria for a person with a substance use disorder
  • • Contain information relevant to treatment planning and recorded in the ASAM 6 dimensions
  • Additional Services Required

    Participating CCBHCs must provide additional services in order to receive the supplemental wrap payment. These services are not directly reimbursable through MHCP fee-for-service (FFS) billing, but are required and factored in to the wrap payment.

    Preliminary Screening and Risk Assessment

  • CCBHC providers must complete a preliminary screening and risk assessment for all new CCBHC recipients:
  • • New recipients have not received a service at a CCBHC within the last six months
  • • Preliminary screening and risk assessments are required of CCBHC providers but not a billable service
  • • Preliminary screening and risk assessment determines acuity of recipient need:
  • • If crisis need, referred to crisis or detox services
  • • If urgent need, an initial evaluation is scheduled within one business day of the preliminary screening and risk assessment followed by a comprehensive evaluation within 60 days of the preliminary screening and risk assessment
  • • If routine need, an initial evaluation is scheduled within 10 days of the preliminary screening and risk assessment followed by a comprehensive evaluation within 60 days of the preliminary screening and risk assessment
  • Care Coordination

    CCBHC providers must provide required care coordination tasks, which include:

  • • Development of a person or family-centered plan of care
  • • Assistance with obtaining appointments and confirming the appointments were kept
  • • Creation of a crisis plan
  • • Tracking recipient’s medications
  • • Establishing a health IT system that contains the required elements in the CCBHC criteria
  • • Implement care coordination agreements according to required standards in the CCBHC criteria
  • Authorization Requirements

    For SUD services:

  • • CCBHCs may continue to obtain and accept county service agreements to authorize SUD treatment services
  • • For MA fee-for-service CCBHC recipients only, authorization for SUD services (specifically, H0001 comprehensive SUD assessment, H0038 Q2 peer recovery support specialist and H2035 outpatient SUD treatment) can be completed utilizing the Chemical Health Assessment and Treatment Services (CHATS) System. Refer to the user manual for specific instructions
  • For mental health services:

  • • For those services that require prior authorization or ongoing authorization, existing systems and timelines will be used
  • • The initial and comprehensive evaluations can be provided in place of the diagnostic assessment
  • • The functional assessment as described here can be provided in place of the current functional assessment
  • • The integrated treatment plan can be provided in place of the individual treatment plan
  • Billing Expanded CCBHC Services

    Follow the billing guidelines in the following tables.

    General Billing Guidelines

  • • CCBHC billing is subject to the same standards outlined in the MHCP Billing Policy manual page.
  • • Bill all mental health CCBHC services as a professional claim in the 837P electronic claim format.
  • • Bill outpatient chemical dependency service claims as an institutional (837I electronic format) or a professional claim (837P electronic claim format).
  • Submit any non-CCBHC services delivered by CCBHC providers separately from CCBHC service claims.

  • Code

    Modifier

    Description

    Unit

    90791

    Q2 52

    Initial evaluation

    1 session

    90791

    Q2 52 HN

    Initial evaluation completed by a clinical trainee

    1 session

    90792

    Q2 52

    Initial evaluation with medical services

    1 session


    Comprehensive Evaluation

    Code

    Modifier

    Description

    Unit

    90791

    Q2

    Comprehensive evaluation

    1 session

    90792

    Q2

    Comprehensive evaluation completed with medical services

    1 session

    90791

    Q2 HN

    Comprehensive evaluation completed by a clinical trainee

    1 session

    90791

    Q2 TG

    Extended comprehensive evaluation

    1 session

    90791

    Q2 TG HN

    Extended comprehensive evaluation completed by a clinical trainee

    1 session

    90792

    Q2 TG

    Extended comprehensive evaluation with medical services

    1 session

  • • Utilize the DC:0-5R diagnostic system for assessment of children up to 5 years old and bill as an extended comprehensive evaluation.
  • • When billing an extended comprehensive evaluation, follow current guidance for extended diagnostic assessment.

  • Integrated Treatment Plan

    Code

    Mod

    Brief Description

    Units

    H0032

    Q2 UD

    Service plan development by non-physician

    Per 15 mins

    H0032

    Q2 UD TS

    Service plan development by non-physician update

    Per 15 mins

  • • CCBHC cannot bill for service plan development using (H0032) for an individual or family community support plan (ICSP or ICFSP) completed by a CCBHC targeted case manager. This does not preclude billing for an integrated treatment plan (service plan development or service plan update) by qualified CCBHC staff. This assumes that qualified staff are not duplicating the targeted case manager’s work, but coordinating with the targeted case manager and approaching development of the integrated treatment plan from an integrated perspective, incorporating other service lines and care coordination.

  • Clinical Care Consultation for Recipients 21 Years Old or Older

    Procedure Code

    Modifier

    Brief Description

    Unit

    90899

    Q2 U8

    Clinical care consultation, face-to-face

    5 to 10 minutes

    90899

    Q2 U9

    Clinical care consultation, face-to-face

    11 to 20 minutes

    90899

    Q2 UB

    Clinical care consultation, face-to-face

    21 to 30 minutes

    90899

    Q2 UC

    Clinical care consultation, face-to-face

    31 minutes and above

  • • Submit one claim line per day for each service. (Add up all the minutes of service provided for face-to-face or non-face-to-face services for each client for that day and submit a single claim regardless of the number of consultations.) Use modifier U4 for non-face-to-face service.
  • • For recipients under 21 years of age, use the billing codes outlined in the MHCP Provider Manual page for Children’s MH Clinical Care Consultation.

  • Family Psychoeducation Benefits for Adults 21 Years Old and Older

    Proc Code

    Modifier

    Brief Description

    Unit

    H2027

    Q2

    Family psychoeducation individual (with a single recipient)

    15 min

    Q2 HQ

    Family psychoeducation recipient group (with multiple recipients)

    Q2 HR

    Family psychoeducation recipient and family (with a single recipient and his or her family)

    Q2 HS

    Family psychoeducation family (with a single family individual not present)

    Q2 HQ HR

    Family psychoeducation family group (with multiple families with individuals present)

    Q2 HQ HS

    Family psychoeducation family group (with multiple families individuals not present)

  • • Submit claims only for the recipient who is the primary subject of the family psychoeducation sessions, regardless of the number of other family or group members in the session.
  • • When more than one family member is a recipient (such as two or three siblings, each receiving treatment within a specific timeframe), bill only for the time spent conducting family psychoeducation with each recipient.
  • • When two professionals render group family psychoeducation, submit only one claim for each recipient. Professionals must determine which recipient they will bill for or one professional may claim for all recipients and reimburse the other professional.
  • • Enter the treating provider NPI number on each claim line.
  • • Use HN modifier for services performed by a clinical trainee.
  • • For recipients under 21 years of age, use the billing codes outlined in the Family Psychoeducation for Children and Youth section of the MHCP Provider Manual.

  • Functional Assessment

    Code

    Mod

    Brief Description

    Units

    H0031

    UD

    Mental health assessment, by non- physician

    Per 15 min

    H0031

    UD TS

    Mental health assessment, by non-physician, follow-up service (review or update)

    Per 15 min

    H0031

    UA UD

    Administering and reporting standardized measures

    Per 15 min

  • • CCBHC cannot bill for functional assessment (H0031) completed by the CCBHC’s targeted case manager.

  • CCBHC Peer Specialist Services

    Code

    Mod

    Brief Description

    Units

    H0038

    MH peer services by level I certified peer specialist

    15 min

    U5

    MH peer services by level II certified peer specialist

    HQ

    MH peer services in a group setting

    H0038

    Q2

    Certified peer recovery specialist

    15 min

    H0038

    HA

    Certified family peer specialist services

    15 min

    HA HQ

    Certified family peer specialist services in a group setting


    Comprehensive Substance Use Disorder Assessment

    Code

    Mod

    Brief Description

    Units

    H0001

    Comprehensive substance use disorder assessment

    Per session

  • • If billing as an institutional claim, use revenue codes: 0944 (Drug), 0945 (Alcohol), or 0953 (Drug and Alcohol).
  • Additional CCBHC Billing and Payment Provisions

    CCBHCs are eligible to receive up to four kinds of MA payment for CCBHC services:

  • • As enrolled providers of statewide covered services such as outpatient MH and SUD services, MH-TCM, ARMHS, CTSS and other services, CCBHCs receive payment at the same rates and within the same claims processing methodology and restrictions as other similarly enrolled providers. If the recipient is in managed care, the managed care organization (MCO) continues to pay these claims.
  • • CCBHCs can receive payment for new and expanded services, which are only available as part of the CCBHC demonstration (see notes on Scope of Services table and MHCP Provider Manual sections pertaining to each of these services). If the recipient is in managed care, these claims are paid by the MCO, with the exception of H0014 Withdrawal Management Level 2, which is paid through fee-for-service (FFS) for all MA recipients. See CCBHC rate schedule.
  • • Based on the claims paid in the two methods above, including managed care, DHS (not the MCO) makes a monthly supplemental wrap payment (see below for details).
  • • CCBHCs are eligible to receive quality bonus payments averaging up to five percent of the other payments above. DHS (not the MCO) will make quality bonus payments after the end of each demonstration year, based on each CCBHC’s performance on outcome measures.
  • Supplemental Wrap Payments
    The CCBHC demonstration project provides for a cost-based prospective payment system (PPS) rate for each clinic. The rate is based on a cost report from each clinic, using federal cost reporting rules. The cost report includes anticipated changes in costs, which are necessary costs to comply with CCBHC criteria. The report also includes historical and projected numbers of qualifying encounters or visits. DHS and a contracted accounting firm have reviewed all cost reports and determined rates for each CCBHC. Total approved costs for demonstration year one divided by total anticipated encounters arrive at a PPS rate per encounter. The rate represents an average cost per encounter for all clients receiving CCBHC services from a particular CCBHC. The rate includes the cost of providing services listed in the Scope of Services table.

    A qualifying encounter is the first billable unit for a CCBHC service on a given service date, for dates of service between July 1, 2017, to June 30, 2019. Billable unit is defined by billing policies that apply to each procedure code. Since MH-TCM is currently paid in monthly units, only one service date per month counts as a qualifying CCBHC encounter. Likewise, other services (such as extended diagnostic assessments) that may involve more than one day of actual service, but only one billing unit, are counted as one encounter for purposes of the wrap payment. Staff travel (H0046) is included only if it is required to provide a CCBHC service.

    CCBHCs do not submit a separate claim for the wrap payment. DHS and a contractor calculate the monthly wrap payment by analyzing all claims processed for a CCBHC during the preceding month for CCBHC procedure codes. DHS determines the wrap payment by the following formula:

  • • The full PPS rate is assigned to each qualifying encounter (i.e. one service date per client)
  • • The PPS rate is offset by all payments for all CCBHC services on that date of service for that client, including MMIS-FFS, MCO payments, Medicare, spenddown, family deductibles, third party liability, etc.
  • • The difference between the PPS rate and the payments is the wrap payment per person per date of service
  • • The amounts in the third bullet may be positive or negative. All of these amounts are added up for each CCBHC for a given month. Since the PPS rates are, on average, about double the current payment levels, we expect the total wrap payment per CCBHC will always be positive
  • • Wrap payment amounts will be continually adjusted back to the start of the demo (July 1, 2017) if previously processed claims are replaced or changed in any way that affects the wrap calculation
  • Legal References

    Minnesota Rule 245.735, Excellence in Mental Health Demonstration Project
    Public Law 113-93

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