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Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP)

Revised: 03-03-176

  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Billing
  • Authorization
  • Legal References
  • Dialectical behavior therapy intensive outpatient program (DBT IOP) is a treatment program that uses a combination of individualized rehabilitative and psychotherapeutic interventions. A DBT IOP involves weekly individual therapy, weekly group skills training, telephone coaching as needed and weekly consultation team meetings.

    Eligible Providers

    Certified DBT IOP teams and their affiliated individual DBT IOP providers are eligible providers.

    Eligible Teams

    To be eligible to bill for DBT IOP services, each DBT IOP team must be certified through the Department of Human Services’ application process.

    Each team comprises, at a minimum:

    • A team leader who is an enrolled mental health professional with a specialty in DBT IOP

    • Other individual treating providers trained in DBT

    To maintain eligibility, certified DBT IOPs must meet all certification standards ongoing and submit proof through an application and onsite review to obtain a recertification.

    Individual Provider Qualifications

    A team leader must meet all the following requirements:

  • • Be an enrolled mental health professional
  • • Be employed by, affiliated with or contracted by a DHS-certified DBT program
  • • Have competencies and working knowledge of DBT principles and practices
  • • Have knowledge of and the ability to apply the principles and DBT practices that are consistent with evidence-based practices
  • A team member must be one of the following:

  • • An enrolled mental health professional
  • • A mental health practitioner clinical trainee
  • • A mental health practitioner
  • A team member must meet all the following requirements:

  • • Be employed by, affiliated with or contracted by a DHS-certified DBT program
  • • Have appropriate competencies and knowledge of DBT principles and practices, or obtain these competencies and knowledge within the first six months of becoming part of a DBT program
  • • Have knowledge of and the ability to apply the principles and practices of DBT consistent with evidence-based practices, or obtain the knowledge and ability within the first six months of becoming part of a DBT program
  • • Participate in DBT consultation team meetings for the recommended duration of 90 minutes per week
  • • If the team member is a mental health practitioner or mental health practitioner clinical trainee, receive ongoing clinical supervision from a qualified clinical supervisor who has appropriate competencies and working knowledge of DBT principles and practices
  • A certified DBT IOP provider must complete the Program Staff and Qualifications Update (DHS-6422) (PDF) when the status of any team member changes. To fill out the Program Staff and Qualifications Update, you must use your unique MN–ITS login and password, which are used to access the online certification and recertification applications for DBT IOPs.

    Eligible Recipients

    A recipient of DBT must meet all the following admission criteria:

  • • Be at least 18 years old
  • • Meet one of the following two criteria:
  • • Have a diagnosis of borderline personality disorder
  • • Have multiple mental health diagnoses; exhibit behaviors characterized by impulsivity, intentional self-harm behavior or both; and be at significant risk of death, morbidity, disability or severe dysfunction across multiple life areas
  • • Have mental health needs that cannot be met with other available community-based services or that need services provided concurrently with other community-based services
  • • Be at risk of one of the following, as recorded in the recipient’s record:
  • • A need for a higher level of care, such as hospitalization or partial hospitalization
  • • Intentional self-harm (suicidal and non-suicidal) or risky impulsive behavior or be currently having chronic self-harm thoughts or urges (suicidal or non-suicidal) although the recipient has managed to not act on them. Recipients with chronic self-harm thoughts and urges are at a greater risk of decompensation
  • • A mental health crisis
  • • Decompensation of mental health symptoms; a change in recipient’s composite LOCUS score, though not required, demonstrates risk of decompensation
  • • Understand and be cognitively capable of participating in DBT as an intensive therapy program
  • • Be able and willing to follow program policies and rules assuring the safety of self and others
  • To remain in DBT, a recipient must meet all the following continued-stay criteria:

  • • Be actively participating and engaged in the DBT program, its treatment components and its guidelines in accordance with treatment team expectations
  • • Have made demonstrable progress as measured against the recipient’s baseline level of functioning before the DBT intervention. Examples of demonstrable progress include:
  • • Decreased self-destructive behaviors
  • • Decreased acute psychiatric symptoms with increased functioning in activities of daily living
  • • Objective signs of increased engagement
  • • Reduced number of acute care services, such as emergency department (ED) visits, crisis services and hospital admissions
  • • Application of skills learned in DBT to life situations
  • • Continue to make progress toward goals but have not fully demonstrated an internalized ability to self-manage and use learned skills effectively
  • • Be actively working toward discharge, including concrete planning for transition and discharge
  • • Have a continued need for treatment as indicated in the above criteria and by ongoing documented evidence in the recipient’s record
  • To be discharged from DBT, one of the following discharge criteria must be met:

  • • The recipient’s individual treatment plan goals and objectives have been met, or the recipient no longer meets continuing-stay criteria
  • • The recipient’s thought, mood, behavior or perception has improved to a level for which a lesser level of service is indicated
  • • The recipient chooses to discontinue the treatment contract
  • • The provider concludes the client will no longer benefit from DBT services after a clinical assessment
  • • The provider will complete paperwork and refer client to needed services
  • Covered services

    Individual DBT IOP

    DBT IOP must provide individual DBT IOP by a qualified member of the certified team for the recommended duration of one hour per week. One of the following qualified team members provide individual DBT IOP:

  • • Mental health professional
  • • Mental health practitioner clinical trainee
  • Individual DBT IOP is a combination of individualized rehabilitative and psychotherapeutic interventions to treat suicidal and other dysfunctional coping behaviors and to reinforce the use of adaptive skillful behaviors by:

  • • Identifying, prioritizing and sequencing behavioral targets
  • • Treating behavioral targets
  • • Generalizing dialectical behavior therapy skills to recipients’ natural environment by providing DBT IOP telephone coaching outside of scheduled office hours, 24 hours a day, 7 days per week while observing therapist’s limits
  • • Measuring progress toward dialectical behavior therapy targets
  • • Managing crisis and life-threatening behaviors
  • • Helping recipients learn and apply effective behaviors in working with other treatment providers. If someone other than the individual therapist provides phone coaching, that person must be another member of the DBT IOP team trained in phone coaching protocol.
  • DBT Group Skills Training

    DBT IOP group skills training is a combination of individualized psychotherapeutic and psychiatric rehabilitative interventions conducted in a group format to reduce suicidal and other dysfunctional coping behaviors and restore function through teaching the following adaptive skills modules:

  • • Mindfulness
  • • Personal effectiveness
  • • Emotion regulation
  • • Distress tolerance
  • DBT IOP must provide group skills training by qualified members of the certified team for a minimum of two hours a week with the option to last up to two and a half hours. A combination of any of the following qualified team members may provide group skills training:

  • • Two mental health professionals
  • • One mental health professional co-facilitating with one mental health practitioner
  • • One mental health professional with one mental health practitioner clinical trainee
  • A mental health professional or mental health practitioner clinical trainee must determine the need for individual DBT skills training (delivered outside a group setting) and indicate that need on the prior authorization form.

    Billing

    DBT Benefits: All Services Require Prior Authorization

    Code

    Mod

    Brief Description

    Units

    Service Limitation

    H2019

    U1

    Individual DBT therapy

    15 min

    Up to 26 hours (104 units) per six months

    H2019

    U1
    HN

    Individual DBT therapy by clinical trainee

    15 min

    H2019

    U1
    HQ

    Group DBT skills training

    15 min

    Up to 78 hours (312 units) per six month

    H2019

    U1
    HQ
    HN

    Group DBT skills training by clinical trainee

    15 min

    Authorization

    DBT IOP requires prior authorization.

    A recommendation for DBT IOP must be based on a comprehensive assessment, including: a diagnostic assessment, a functional assessment and a review of the recipient’s prior treatment history by the DBT IOP team to determine that DBT IOP services are medically necessary. The clinical supervisor must review comprehensive evaluation completed by a clinical trainee.

    Seek authorization in six-month increments.

    For initial authorization, submit the MHCP Authorization Form (DHS-4695) (PDF) and MHCP Initial DBT Authorization Form (DHS-6322) (PDF).

    MHCP Authorization Form (DHS-4695) (PDF)

  • Under the Pay-to Provider Information heading, complete the following:
  • • Pay-To Provider Name: Enter the name of the organization with the certified DBT Program
  • • NPI/UMPI: Enter the NPI number for the pay-to organization
  • • Taxonomy Code: Fill in, when applicable
  • MHCP Initial DBT Authorization Form (DHS-6322) (PDF)

    Complete all the requested information on the form, including the MN–ITS document number and the recipient number, and submit with the following supporting documentation:

  • • The client’s most recent diagnostic assessment (DA) or diagnostic update conducted by a mental health professional or a mental health practitioner working as a clinical trainee and reviewed by the DBT program
  • • The client’s most recent functional assessment (FA). The FA:
  • • Must address domains of life areas (mental health symptoms, mental health service needs, use of drugs or alcohol, vocational functioning, educational functioning, social functioning, interpersonal functioning, self-care and independent living skills, medical health, dental health, maintaining financial, obtaining and maintaining housing)
  • • Should not be based on historical or predicted functions
  • • Must be completed every six months
  • • May be completed by another service provider within the last six months as long as the information it contains reflects current functioning
  • • The client’s personal commitment or contract to enter the DBT program
  • • The client treatment plan that includes goals for stage one DBT treatment
  • • The LOCUS Recording Form (DHS-6249) (PDF), if available
  • For additional information, submit the Authorization Form (DHS-4695) (PDF) and MHCP Additional DBT Authorization Form (DHS-6322A) (PDF).

    MHCP Authorization Form (DHS-4695) (PDF)

  • • Under the Authorization Information heading, Change to Existing Authorization: Enter the initial prior authorization number
  • • Under the Pay-to Provider Information heading:
  • • Pay-To Provider Name: Enter the name of the organization with the certified DBT program.
  • NPI/UMPI: Enter the pay-to organizations NPI number
  • • Taxonomy Code: Fill in, when applicable
  • MHCP Additional DBT Authorization Form (DHS-6322A) (PDF)

  • • Enter the MN−ITS document number
  • • Enter the recipient number
  • • Complete all the requested information on the form and submit the following supporting documentation:
  • • Diagnostic assessment or diagnostic update only if significant change has occurred since initial authorization
  • • The client’s most recent functional assessment (FA)
  • • The updated treatment plan
  • • Four individual and four group skills progress notes (for a total of eight progress notes) since the initial authorization that indicate progress made and the ongoing goals for DBT treatment
  • • The LOCUS Recording Form (DHS-6249) (PDF), if available
  • Submit the reauthorization request within 10 days of completing the units initially authorized. Do not submit an authorization request for a span of time that overlaps a previously authorized span.

    Exclusionary Services
    Additional justification is needed if DBT IOP is provided concurrently with one of the following exclusionary services:

  • • Partial hospitalization
  • • Outpatient individual or group psychotherapy
  • • Day treatment
  • When provided concurrently with DBT IOP, the above services require prior authorization. If exclusionary services are provided on the same day as DBT IOP without authorization, the MMIS claims system will make an adjustment to pay the DBT provider first and take back payment from the exclusionary service.

    Legal References

    Minnesota Statutes 256B.0625, subd. 5l (Intensive mental health outpatient treatment)
    Minnesota Rule 9505.0370, Subd. 12
    (Definitions)
    Minnesota Rule 9505.0372, Subd. 10
    (Covered Services)

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