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Continuum of Care Pilot

Revised: 10-25-2016

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Service Agreement Requirements
  • Billing
  • CHATS and POMS
  • Managed Care Recipients
  • Legal References
  • In addition to the policies and billing procedure exceptions listed in this section for the Continuum of Care (COC) Pilot providers and recipients, the policies and billing procedures in the Alcohol and Drug Abuse Services section remain in effect for all chemical health providers and recipients.

    Overview

    The COC Pilot is a pilot project that measures direct client access to, and utilization of, Substance Use Disorder (SUD) treatment services in the selected pilot areas. These pilot areas will focus on:

  • • Improving access to treatment and the assessment process for SUD treatment
  • • Using care coordination to improve continuing care for people with SUD
  • • Using trained peer support specialists to provide enhanced community support for people with SUD
  • • Promoting telehealth technologies to improve access and as one SUD treatment and recovery support strategy
  • Effective for dates of service October 27, 2014, and after, the Consolidated Chemical Dependency Treatment Fund (CCDTF) began covering the COC Pilot for eligible providers and recipients. Each participating entity may have a different start date.

    Eligible Providers

    To be eligible to participate in the COC Pilot you must be a provider residing and doing business in White Earth or Red Lake reservation, have a contract to participate on file with MHCP, and complete the COC Pilot training.

    Exception: Womens Wellbriety Center and Oshki Manidoo New Spirit Center do not need to meet the criteria of being located on tribal land.

    Participating tribal nations and providers include the following:

    White Earth Nation – Implementation date October 27, 2014

  • • Circle Back Center
  • • Oshki Manidoo New Spirit Center
  • • White Earth Chemical Health – Naytahwaush
  • • White Earth Chemical Health – Ogema
  • • White Earth Chemical Health – Ponsford
  • • White Earth Chemical Health – White Earth
  • • Womens Wellbriety Center
  • • White Earth Mens Substance Abuse PC
  • Red Lake Nation– Implementation date February 19, 2015

  • • Red Lake Group Home
  • • Red Lake Treatment Center
  • • Red Lake Outpatient – Ponemah
  • • Red Lake Outpatient – Red Lake
  • Pilot providers will be acting as placing authorities and are responsible for client clinical and financial eligibility assessment.

    Eligible Recipients

    Consolidated Chemical Dependency Treatment Fund (CCDTF) and MA recipients residing in the tribal pilot areas and not enrolled in an MCO are eligible to participate. American Indians on CCDTF, MA or an MCO are eligible to participate.

    American Indian and non-American Indian eligibility for COC Pilot

    Major programs

    American Indian residing in the participating tribal land

    Non-American Indian residing in the participating tribal land

    MA

    Eligible

    Eligible

    CCDTF

    Eligible

    Eligible

    Managed Care Organizations (MCO) Enrollees

    Eligible

    Non-Eligible

    Use MN–ITS to verify MHCP recipient eligibility. If a client is not found or has inactive eligibility status, determine client eligibility for CCDTF.

    CCDTF Eligibility Determination

    Eligibility for CCDTF is based on two criteria: clinical need and financial eligibility. If a person is determined to have both a clinical need for treatment and be financially eligible for the CCDTF, then the CCDTF can pay for the person’s chemical dependency (CD) treatment services. For an eligible recipient who does not have a recipient ID, complete a Client Placement Authorization (DHS-2780) (PDF) and fax it to ADAD at 651-431-7471.

    Clinical Eligibility
    Clinical eligibility is based on the comprehensive assessment result. This is an in-person face-to-face or telehealth interview that follows the approved guidelines and is conducted by a qualified assessor. A qualified assessor is a member of the staff of an Eligible Provider who meets requirements in Rule 31 or applicable tribal standards.

    The assessor gathers information using the approved comprehensive assessment format and the Minnesota Matrix (DHS-5204B) (PDF) to determine clinical eligibility. A person who scores a severity rating of 2, 3 or 4 in Dimension IV, V or VI meets clinical eligibility requirements for treatment. The three new pilot services (Comprehensive Substance Use Disorder Assessment, care coordination, and peer recovery support services) do not have to fall within the severity rating required for formal treatment services, but still require at least a severity rating of 1 in at least one of the six dimensions.

    Financial Eligibility
    Financial eligibility has two parts:

    1.

    A person who has private, commercial insurance that covers 100 percent of the type and length of treatment he or she needs is not eligible for the CCDTF. A person who has less than 100 percent coverage (for example, has a copay, a deductible or pays a percentage of the the costs), may be eligible.

    2.

    The person must meet the CCDTF financial eligibility guidelines. The CCDTF financial eligibility guidelines are 133 percent (275 percent for minors and 278 percent for pregnant women) of the Federal Poverty Guidelines (FPG) based on the CCDTF definitions of household size and income.

    Covered Services

    The COC Pilot covers services on or after your organization’s implementation date. The assessment date must be on or after the implementation date.

    Covered Pilot services are the following:

  • • Comprehensive Substance Use Disorder Assessment (chemical dependency assessment) – this assessment is a face-to-face or approved telehealth interview, conducted by a qualified assessor to determine both the proper placement in treatment services and the ongoing individual treatment plan. The assessment creates a full clinical picture of treatment needs and leads to referral to the appropriate level of care with the appropriate provider using the Minnesota Matrix criteria.
  • • Care coordination – services designed to help the client obtain other services and to support the client’s need and efforts to establish a lifestyle free of the harmful effects of substance use disorders. Alcohol and drug abuse counselors qualified according to Minnesota Rules must provide these services, unless the person providing the service is specifically qualified according to the accepted standards of that profession.
  • • Peer recovery support services – services provided by a person who has received training, usually from the existing Recovery Community Organizations, to connect the clients with peer-based, community-involved, ongoing support. Staff can receive this training on the job. These services can link the client to strong recovery-oriented resources in their local environment that will nurture their growth.
  • Care coordination and peer recovery support are covered for recipients who are currently receiving treatment services and were admitted for that treatment prior to the organization’s implementation date.

    Telehealth

    You may use telehealth in the pilot project to help clients access treatment throughout the course of their care. Set up access to telehealth services using the DHS-approved telehealth set-up. Complete the Minnesota Continuum of Care Pilot Enrollment Form for Vidyo (DHS-7034) (PDF) and fax it to Alcohol and Drug Abuse Division (ADAD) at 651-431-7449. Staff will review your request and the Office of Tele-Community Development will contact you about a start-up plan.

    For questions about the Vidyo application, such as connectivity or bandwidth, contact the Tele-Community Development office directly at 651-431-2070.

    Noncovered Services

    Assessment, care coordination, and peer support services are not covered for:

  • • More than one assessment within a six month span for the duration of the Pilot. Assessment updates are billed as Care Coordination encounters.
  • • Recipients living outside of the pilot tribal land
  • • Recipients who live in the pilot areas and access service:
  • • Outside of pilot areas, or
  • • Through a nonparticipating provider*
  • • Services from a provider doing business outside of the pilot areas
  • • Services from a providers who opts out of the pilot
  • • Non-American Indians who live in the pilot tribal land and enroll in an MCO health plan
  • *A nonparticipating provider is a provider doing business outside of a pilot area or doing business in a pilot area, but who has opted out of participating in the Continuum of Care Pilot.

    Service Agreement

    Service agreements (SA) are temporarily required for all services including assessment, care coordination and peer support services. After you determine that a person meets both the clinical and financial requirements for CCDTF eligibility, complete a Client Placement Authorization (CPA) (DHS-2780) (PDF), record the parameters of the service authorization and fax it to ADAD at 651-431-7471. ADAD will create an SA and notify you and the recipient. Include the SA number on the claim.

    ADAD is working on improving the direct client access model by minimizing the SA requirements. We will inform you when this process is ready.

    Billing

    Refer to MHCP Provider Manual, Alcohol and Drug Abuse Services section, Billing subsection for billing existing revenue and procedure (primary treatment service) codes.

    The following are the COC Pilot procedure codes and modifiers. Bill the COC Pilot services and primary treatment services on separate claims through MN–ITS DDE or Batch. Incorreclty billing the combination of primary services and COC Pilot services on the same claim may result in incorrect claim payment.

    Provider type and procedure code table

    Provider Type

    Revenue Code

    HCPCS procedure code and rate per unit

    Modifier

    Claim Format

    Type of Bill

    Inpatient hospital


    None


    H0001 (Assessment)

    T1016 (Care coordination)

    H0038 (Peer support services)




    SE




    837P




    None

    Residential programs

    Non-residential clinic programs

    Non-residential outpatient programs

    0944
    0945
    0953


    837I or 837P

    89X or 13X

    Modifier SE applies to the new COC Pilot procedure codes above only and must be included on the SA and claim service line. Do not add SE with existing procedure codes.

    Service Description and Rates

    Comprehensive Substance Use Disorder Assessment: $157.50 per unit (1 unit per session, once every six month span.)

    Care coordination: $17.50 per unit (15 minutes per unit, maximum eight units per day)

    Peer support services: $11.38 per unit (15 minutes per unit, maximum eight units per day)

    CHATS and POMS

    Pilot providers are required to report and maintain current client records on CHATS system and Pilot Outcomes Monitoring System (POMS). Refer to the CHATS and POMS process below for details. Contact the CHATS coordinator at 651-431-2631 or send a request to DHS.CHATS@state.mn.us to obtain the necessary training and documents required to participate in CHATS and POMS.

    Use the CHATS and POMS data collection systems to participate in the pilot program and receive reimbursement for the Comprehensive Substance Use Disorder Assessment, care coordination and peer support services.

    Chemical Health Assessment and Treatment Services (CHATS) System

    CHATS is a web-based system used for monitoring delivery of assessments and treatment services. Refer to the CHATS User Manual (DHS-7076) (PDF) for instructions.

    Pilot Outcomes Monitoring System (POMS)

    POMS is a paper-based data collection system that is intended to assess overall outcomes, performance and client change over the time the client is participating in the Continuum of Care Pilot project. For step-by-step instructions on how to complete the POMS forms, refer to the POMS User Manual (DHS-7042) (PDF). Mail (do not fax) completed POMS forms to:

    POMS Project
    Minnesota Department of Human Services
    Alcohol & Drug Abuse Division
    444 Lafayette Road
    St. Paul, MN 55155-0986

    Use the Continuum of Care Pilot - POMS Forms Submission Check List (DHS-7041) (PDF) for your internal use only.

    CHATS and POMS Process

    Steps

    CHATS (Log in to CHATS to complete the following:

    POMS (Complete paper forms and mail to DHS)

    1. Service request

    Complete the Client Profile and Assessment Information tabs for all clients who received chemical dependency assessment.

    2. Authorization determination

    If client placement is authorized, complete the Treatment Services, Care Coordination and Peer Support tabs as encounters are delivered to the client.

    If client placement is not authorized, move to step 3 and close the CHATS record.

    If services are authorized in CHATS, complete the POMS Admission Form (DHS-7038) (PDF)

    Complete the POMS Update Form (DHS-7039) (PDF) every three months until the client is terminated in CHATS

    Have the client complete the POMS Client Satisfaction Survey (DHS-7040) (PDF) every six months until the client is terminated in CHATS

    3. Discharge

    Complete the termination tab when the client will no longer receive services.

    Complete the POMS Update Form (DHS-7039) (PDF), including the discharge items

    Have the client complete a Client Satisfaction Survey (DHS-7040) (PDF)

    4. Post-discharge

    Complete a six-month post-discharge POMS Update Form (DHS-7039) (PDF)

    Have the client complete a Client Satisfaction Survey (DHS-7040) (PDF)

    Managed Care Recipients

    Except for American Indian recipients, the COC Pilot project excludes MCO enrollees.

    Legal References

    Minnesota Statutes 254B.14 (Continuum of Care Pilot Projects; Chemical Health Care)

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