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Children’s Mental Health Crisis Response Services

Revised: 07-10-2013

  • Overview
  • Eligible Providers
  • Initial Application/Provider Certification
  • Recertification
  • Decertification
  • Enrollable Mental Health Agencies
  • Enrollable Mental Health Professionals
  • Eligible Recipients
  • Covered Services
  • Crisis Assessment
  • Crisis Intervention
  • Crisis Stabilization
  • Noncovered Services
  • Billing for Children’s Crisis Response Services
  • Definitions
  • Legal References
  • Overview

    Children’s mental health crisis response services are intensive face-to-face, short-term mental health services initiated during a crisis to help the child/youth return to their baseline level of functioning. Children’s crisis response services must be provided on-site by a mobile crisis response team outside of urgent care, inpatient or outpatient hospital settings.

    Crisis response providers must be experienced in mental health assessment, crisis intervention techniques, have emergency clinical decision-making abilities and knowledge of local services and resources.

    Eligible Providers

    A provider agency must be approved for primary certification.

    Initial Application/Provider Certification

    The Crisis Response Services provider certification process includes Primary Certification. Primary Certification involves approval and acceptance of the provider agency’s application based on whether the agency meets the standards in accordance with MS 256B.0944.

  • 1. Review the Children’s Mental Health - Crisis Response Services – Primary Certification Guide (DHS-4985A-ENG)
  • 2. Submit the Children’s Mental Health - Crisis Response Services – Primary Certification Application – Part 1 (DHS-4985-ENG)
  • 3. Wait to hear from the Children’s Mental Health Division to ensure that you have been certified to provide Crisis Response Services prior to billing.
  • The Crisis Response Services provider is responsible to provide and ensure that all of the Crisis Response Service components are available when the recipient needs them. If the provider cannot ensure that all of the service components would be available, the application will not be approved.

    Recertification

    Crisis Response Service providers must complete recertification 4 months prior to the end of their certification. Two documents were developed for the primary re-certification process.

  • • Children’s Mental Health - Crisis Response Services – Primary Recertification Guide (DHS-4990A-ENG)
  • • Children’s Mental Health - Crisis Response Services – Primary Recertification Application (DHS-4990-ENG)
  • Decertification

    The commissioner may intervene at any time and decertify provider with cause.

    Enrollable Mental Health Agencies

    The following agencies may request DHS primary certification as a crisis response services provider:

  • • County-operated agency
  • • Community Mental Health Center
  • • Indian Health Services/638 facility
  • • Provider under contract with a county to provide crisis response services
  • A mobile crisis intervention team must consist of:

  • • Two or more mental health professionals or
  • • At least one mental health professional and one mental health practitioner.
  • Enrollable Mental Health Professionals

  • LP
  • LPCC
  • LICSW
  • LMFT
  • CNS
  • NP
  • Psychiatrist
  • Mental Health Practitioner
    Mental health practitioners must:

  • • Have completed at least 30 hours of crisis intervention and stabilization training during the past two years;
  • • Be consulted by the clinical supervisor, in person or by phone, during the first three hours the practitioner provides on-site services;
  • • Be under clinical supervision by an MHCP-enrolled mental health professional who is
  • • employed by or under contract with the crisis response provider; and
  • • accepts full responsibility for the services provided. The clinical supervisor must:
  • • Be immediately available to staff by phone or in person;
  • • Document consultations;
  • • Review, approve, and sign the crisis assessment and treatment plan performed by mental health practitioners within one day; and
  • • Document on-site observations in the recipient’s record.
  • MHCP strongly encourages MHCP-enrolled crisis response services providers to contract with each health plan in their service area. Contact the appropriate managed care organization using the MHCP Health Plan Contact chart.

    Mental Health and Chemical Dependency Services also have contact charts.

  • Medical Assistance PMAP and MinnesotaCare Contact Grid for Mental Health and Chemical Dependency Services for Metro Are Residents (DHS-4485-ENG)
  • Greater Minnesota PMAP and MinnesotaCare Contact Grid for Mental Health and Chemical Dependency Services (DHS-4484-ENG)
  • Eligible Recipients

    To be eligible for MHCP children’s crisis response services, a recipient must:

  • • Be eligible for MA;
  • • Be under age 21;
  • • Be experiencing a mental health crisis or emergency; and
  • • Meet the criteria for emotional disturbance (age 0-18) or mental illness (age 18 to 21).
  • Covered Services

    Crisis response services include:

  • Crisis Assessment;
  • Crisis Intervention; and
  • Crisis Stabilization.
  • Crisis Screening

    Prior to doing crisis assessment conduct a screening of the potential crisis situation. The screening must:

  • • Gather information;
  • • Determine whether a crisis situation exists;
  • • Identify the parties involved; and
  • • Determine an appropriate response.
  • This is not a MHCP covered service.

    Crisis Assessment

    A crisis assessment is an immediate, face-to-face evaluation by a physician, mental health professional or practitioner, to determine the recipient’s presenting situation, and identifying any immediate need for emergency services.

  • • Provide immediate intervention to provide relief of distress based on a determination that the child’s behavior is a serious deviation from his/her baseline level of functioning;
  • • Evaluate in a culturally appropriate way and as time permits the child’s current:
  • • Life situation and sources of stress;
  • • Symptoms, risk behaviors, and mental health problems;
  • • Strengths and vulnerabilities;
  • • Cultural considerations;
  • • Support network; and
  • • Functioning.
  • Conduct the crisis assessment in the recipient’s home, the home of a family member, or another community location. Determine the need for crisis intervention services or referrals to other resources based on the assessment.

    Crisis Intervention

    Crisis interventions are face-to-face, short-term intensive mental health services started during a mental health crisis or emergency to help the recipient:

  • • Cope with immediate stressors and lessen his/her suffering;
  • • Identify and use available resources and recipient’s strengths;
  • • Avoid unnecessary hospitalization and loss of independent living;
  • • Develop action plans; and
  • Begin to return to his/her baseline level of functioning.
  • Crisis intervention services must be
  • • Available 24 hours per day, seven days per week, 365 days per year;
  • • Provided on-site by a mobile team in a community setting; and
  • • Provided promptly.
  • Crisis Intervention Treatment Plan

    With the child and the child’s family, develop, document and implement an initial crisis plan within 24 hours of the initial intervention to reduce or eliminate the crisis:

  • • List the child’s needs and problems identified in the crisis assessment;
  • • Identify
  • • Frequency and type of services to be provided and
  • • Measurable short-term goals;
  • • Specify objectives directed toward the achievement of each goal;
  • • Note cultural considerations;
  • • Recommend needed services, including crisis stabilization;
  • • Refer to appropriate local resources, such as the county social services agency, mental health services, local law enforcement;
  • • Write clear progress notes of the outcome of goals; and
  • • If the recipient has a case manager, coordinate the planning of other services with the case manager.
  • Update the crisis plan as needed to reflect current goals and services.

    If the child shows positive change in a baseline level of functioning or a decrease in personal distress:

  • • Make (and document) a referral to less intensive mental health services, such as CTSS; or
  • • Document that short-term goals have been met and that no further crisis intervention services are needed.
  • The child and/or parent or guardian must sign the crisis plan. If the child and family refuse to approve and sign the plan, the team must note the refusal and the reason(s) for the refusal in the treatment plan. A mental health professional must approve and sign the treatment plan. Give a copy of the treatment plan to the recipient.

    NOTE: If the services continue into a second calendar day, a mental health professional must contact the recipient face-to-face on the second day to provide services and update the crisis plan.

    For this service, “Second calendar day” means 24 hours from the beginning of the face-to-face intervention. The mental health professional is not restricted to only the professional who was supervising the service when the face-to-face intervention began.

    Crisis Stabilization

    Crisis stabilization services are mental health services provided to a recipient after crisis intervention to help the recipient obtain his/her functional level as it was before the crisis. Provide stabilization services in the community, based on the crisis assessment and crisis plan.

    Consider the need for further assessment and referrals. Update the crisis stabilization treatment plan, supportive counseling, skills training, and collaboration with other service providers in the community.

    Crisis Stabilization Plan
    Develop a crisis stabilization plan in partnership with the child and family within 24 hours of beginning services with the participation of the recipient. The crisis stabilization treatment plan, at a minimum, must include:

  • • Problems identified in the assessment;
  • • Concrete, measurable short-term goals and tasks to be achieved including time frames for achievement;
  • • Specific objectives directed toward achieving each goal;
  • • Clear progress notes about outcomes of goals;
  • • List of recipient’s strengths and resources;
  • • Documentation of participants involved and a crisis response action plan, if another crisis should occur; and
  • • Frequency and type of services initiated, including a list of providers, as applicable.
  • The child and/or family must sign the crisis plan. If the child and family refuse to approve and sign the plan, the team must note the refusal and the reason(s) for the refusal. A member of the crisis team must approve and sign the crisis stabilization plan. Give a copy of the plan to the recipient.

    Noncovered Services

    The following services are not covered as crisis response services:

  • • Recipient transporting services;
  • • Crisis response services performed by volunteers;
  • • Provider performance of household tasks, chores, or related activities, such as laundering clothes, moving the recipient’s household, housekeeping, and grocery shopping for the recipient;
  • • Time spent “on call” and not delivering services to recipients;
  • • Activities primarily social or recreational in nature, rather than rehabilitative;
  • • Job specific skills services such as on the job training;
  • • Case management;
  • • Outreach services to potential recipients;
  • • Crisis response services provided by a hospital, board and lodging, or residential facility to a recipient of that facility;
  • • Room and board.
  • Billing for Children’s Crisis Response Services

  • • Use MN–ITS 837P
  • • Bill for direct, face to face service(s) provided to an eligible child by a qualified staff person;
  • • Enter the actual place of service code (POS); POS may not be 23 (emergency department) for mobile team billing;
  • • Enter the individual treating provider NPI
  • • Each team member providing on-site, face-to-face services may bill;
  • • When an off-site team member (professional) works with an on-site team member, the professional may bill for time spent working directly with the on-site member.
  • Proc Code

    Mod

    Service Name

    Eligible Providers

    Unit Length

    S9484

    UA

    Crisis Intervention Mental Health Service

    CNS-MH, LICSW, LMFT, LP, LPCC, Psychiatrist

    60 min

    S9484

    UA
    HN

    Health Services

    MH Practitioners

    60 min

    Definitions

  • Mental health crisis: A behavioral, emotional, or psychiatric situation that would likely result in significantly reduced levels of functioning in primary activities of daily living or in the placement of the recipient in a more restrictive setting.
  • Mental health emergency: A behavioral, emotional, or psychiatric situation which causes an immediate need for mental health services (e.g. 911 call, emergency department visit or inpatient hospitalization).
  • Legal References

    MS 245.487 to 245.4887 Minnesota Comprehensive Children's Mental Health Act
    MS 256B.0943
    Children’s Therapeutic Services and Supports (CTSS)
    MS 256B.0944
    Covered children’s mental health crisis response services

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