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Intensive Treatment in Foster Care

Date: 11-17-2017

Overview

Intensive treatment in foster care (ITFC) is a bundled service for children who are in a family foster care setting with a mental illness diagnosis and require intensive intervention without 24-hour medically monitoring (a CASII score of 4 or higher). The bundled service includes psychotherapy, psycho-education, clinical consultation and crisis assistance performed in addition to prescribed service requirements which are described below.

Eligible Providers

ITFC providers include ITFC certified agencies and their qualified employees enrolled as MHCP providers.

The following entities may request MHCP certification as an ITFC provider and obtain a service contract with a county board or tribe:

  • • An Indian Health Service facility or Rule 638 tribal organization under Title 25, or Title 3 of the Indian Self-Determination Act, Public Law 93-638
  • • A non-county entity
  • All ITFC services provided to MHCP enrollees must be by a qualified mental health professional or a clinical trainee working under the supervision of a licensed mental health professional.

    Provider Responsibilities

    A certified ITFC provider must provide services to the child at least three days per week, for a total of six hours of in-person treatment. Services may be provided to the child, parents, siblings, foster parent and members of the child’s permanency plan and rendered in the child’s home, daycare, school or other community-based setting that is specified on the child’s individualized treatment plan (ITP). Providers must provide ITFC services in a developmentally and culturally appropriate manner and comply with the following requirements:

  • • Each client receiving treatment services must have an extended diagnostic assessment within 30 days of enrollment unless the client has a previous extended diagnostic assessment that the client, parent and mental health professional agree still accurately describes the client’s current mental health functioning.
  • • Request documentation of treatment and assessments the client has received from previous and current mental health, school and physical health providers. Review and incorporate this information into the diagnostic assessment, team consultation and treatment planning process.
  • • Each client must have a crisis assistance plan within ten days of initiating services and must have access to clinical phone support 24 hours per day, 7 days per week, during the course of treatment. The crisis plan must demonstrate coordination with the local or regional mobile crisis intervention team.
  • • Assess each client for a trauma history and the client’s treatment plan must document how the results of the assessment will be incorporated into treatment.
  • • Each client must have an individualized treatment plan that is reviewed, evaluated and signed every 90 days using the team consultation and team treatment planning process.
  • • Deliver services in continual collaboration and consultation with the client’s medical providers and, in particular, with the prescribers of psychotropic medications. Members of the service team must be aware of the medication regimen and potential side effects.
  • • Conduct transition planning for the child starting with the first treatment plan and address throughout treatment to support the child’s permanency plan and post discharge mental health service needs.
  • Eligible Providers

    Treating Providers:

  • Clinical nurse specialist (CNS)
  • Licensed independent clinical social worker (LICSW)
  • Licensed marriage and family therapist (LMFT)
  • Licensed professional clinical counselor (LPCC)
  • Licensed psychologist (LP)
  • Psychiatric nurse practitioner (NP)
  • Psychiatry or an osteopathic physician
  • • Tribal certified professionals
  • Mental health practitioners who are qualified as clinical trainees may also provide ITFC services under the supervision of an eligible treating provider.

    Requirements

    Refer to General MHCP non-enrollable mental health provider requirements for additional practitioner requirements.

    ITFC Certification

    Providers must be certified prior to delivering ITFC services. Certification involves approval and acceptance of the provider agency’s application based on whether the agency meets the statutory standards. ITFCs may be certified for up to three years by the commissioner or designated certification body. Prior to applying for certification, potential ITFC agencies must attend the ITFC applicant training. Registration information can be found under the ITFC Applicant Provider Information Session on the Children’s Mental Health-Training Information page.

    Complete the following three documents for the ITSFC application and certification process:

  • Intensive Treatment in Foster Care Provider Certification Process (DHS-5360A-ENG) (PDF)
  • Intensive Treatment in Foster Care Provider Application Guideline (DHS-5360B-ENG) (PDF)
  • Intensive Treatment in Foster Care Provider Entity Primary Certification Application (DHS-5360-ENG) (PDF)
  • To be certified, providers must be able to deliver the following core services:

  • • Psychotherapy
  • • Psychoeducation
  • • Crisis assistance
  • • Clinical care consultation
  • • Team treatment planning
  • Recertification

    Recertification requires reviewing Recertification Review Process and submitting a recertification application. Recertification will include a site review to examine policies and procedures and clinical documentation of ITFC services.

    Decertification

    The commissioner may intervene at any time and decertify providers with cause. The decertification is subject to appeal to the state.

    Eligible Members

    To be eligible for ITFC, members must have an individual treatment plan (ITP) that clearly documents the necessity for the type of mental health service requested, including intensity of treatment and medical necessity. Members must also:

  • • Have a documented diagnosis of mental illness
  • • Be living in a family foster care setting
  • • Be between the ages of 0-21
  • • Have a level of care evaluation indicating that intensive intervention without 24-hour medically monitoring is required to treat the mental illness
  • A mental health professional or clinical trainee must do the diagnostic assessment establishing eligibility for ITFC within the 180 days prior to the ITFC services beginning.

    Covered Services

    ITFC providers must provide or ensure the following services, as prescribed in the child’s ITP:

  • • Psychotherapy (individual, family and group)
  • • Psychoeducation (individual, family and group)
  • • Crisis assistance
  • • Clinical care consultation
  • Noncovered Services

    Services that are not covered in ITFC but may be billed separately:

  • • Inpatient psychiatric hospital treatment
  • • Mental health targeted case management
  • • Partial hospitalization
  • • Medication management
  • • Children’s mental health day treatment services
  • • Crisis response services
  • • Transportation
  • Services that are not covered under ITFC and are not billable while a child is receiving ITFC services:

  • • CTSS
  • • Mental health behavioral aide services
  • • Home and community-based waiver services
  • • Mental health residential treatment
  • • Room and board costs
  • Authorization

    Refer to Authorization section of the Provider Manual for general authorization policy and procedures. ITFC services authorization is required after 78 units of service.

    Billing

  • • Bill ITSFC services using HCPC code S5145
  • • Bill in MN-ITS using 837I
  • • There are no spacing requirements between sessions
  • • Enter the treating provider NPI number on each claim line
  • Use the following table for billing services with date of service on or after July 1, 2017.

    Intensive Treatment in Foster Care & Other Concurrent Service

    ITFC certified agency must provide all the covered services.
    When requesting authorization, clearly document medical necessity for the additional service(s), including reasons ITFC does not or cannot meet recipient’s needs (e.g., specialty service, transitional service, etc.)

    Other Service

    Is service included in ITFC?

    Can service be provided in addition to ITFC?

    Service Limitations

    MH-TCM

    No

    Yes

    Children’s Mental Health Day Treatment

    No

    Yes

    Day treatment program must request authorization.

    Children’s Residential Treatment Services

    No

    No

    Cannot be billed separately.
    No authorization required.

    Partial Hospitalization

    No

    Yes

    Partial hospitalization thresholds and limitations apply.

    IRTS

    No

    Yes

    ITFC and IRTS may be provided concurrently without authorization.

    CTSS and ARMHS

    No

    No

    Rehabilitative skills training is a not a component of ITFC services and cannot be billed separately.

    Mental Health Behavioral Aide Services

    No

    No

    Cannot be billed separately.
    No authorization required.

    Crisis Assessment and Intervention (mobile)

    No

    No

    Can be billed separately.
    No authorization required.

    Crisis Stabilization – Non-residential

    No

    No

    Cannot be billed separately.

    No authorization required.

    Crisis Stabilization – Residential

    No

    Yes

    Service limits apply.
    Services must be provided with ITFC and residential provider.

    Medication Management

    No

    Yes

    May be provided by physician or advance practice registered nurse with mental health certification.

    Outpatient Psychotherapy

    Yes

    No

    A component of ITFC.
    Cannot be billed separately.
    No authorization required.

    Inpatient Hospitalization

    No

    Yes

    Inpatient hospitalization services are reimbursed separately from ITFC.
    ITFC claims: enter POS code 21.

    Waivered Services

    No

    No

    Cannot be billed separately.

    No authorization required.

    Other medical services (e.g., PCA)

    No

    Yes

    Service limits apply to each service.

    Intensive Treatment in Foster Care

    Proc. Code

    Brief Description

    Unit

    Service Limitation

    S5145 HE

    Intensive treatment in foster care (performed by mental health professional)

    Per diem

    78 Units before Authorization is required.

    S5145 HE HN

    Intensive treatment in foster care (performed by clinical trainee)

    Per diem

    Legal References

    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 256B.0946, Intensive Treatment in Foster Care.

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    © 2017 Minnesota Department of Human Services Updated: 11/17/17 1:05 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 11/17/17 1:05 PM