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Mental Health Targeted Case Management (MH-TCM)

Revised: 05-11-2010

MH-TCM services help adults with a serious and persistent mental illness (SPMI) and children with a severe emotional disturbance (SED) gain access to needed medical, social, educational, vocational, financial and other necessary services as they relate to the recipient’s mental health needs.


Definitions

Individual community support plan (ICSP) or individual family community support plan (IFCSP): A written plan of action developed by a case manager and based on diagnostic and functional assessments, coordinated with an ITP, identifying specific services needed by the:

  • • Adult with SPMI, including:
  • • Goals and objectives of treatment;
  • • Treatment strategy;
  • • A schedule for accomplishing treatment goals and objectives, and
  • • The individual responsible for providing treatment to the adult; or
  • • Child with SED and the child’s family, to:
  • • Treat the symptoms and dysfunctions determined in the diagnostic assessment;
  • • Relieve conditions leading to emotional disturbance and improve the personal well-being of the child;
  • • Improve family functioning;
  • • Enhance daily living skills;
  • • Improve functioning in education and recreation settings;
  • • Improve interpersonal and family relationships;
  • • Enhance vocational development; and
  • • Assist in obtaining transportation, housing, health services, and employment.
  • The case manager works with the recipient, and the recipient’s family in the case of a child, to develop an ICSP or IFCSP.

    Functional Assessment

    Eligible case management service providers must be employed by a county or under contract with a county agency, or for individuals receiving benefits through a managed care health plan, the managed care organization, or tribe to provide MH-TCM services and be:

  • • Mental health symptoms and needs as presented in a diagnostic assessment;
  • • Use of drugs and alcohol;
  • • Vocational and educational functioning;
  • • Social functioning, including the use of leisure time;
  • • Interpersonal functioning, including relationships;
  • • Self-care and independent living;
  • • Medical and dental health;
  • • Financial assistance needs;
  • • Housing and transportation needs;
  • • Current living conditions; and
  • • Other needs and problems.
  • Results of the functional assessment are used to develop the goals and objectives of an ICSP/IFCSP.

    Eligible MH-TCM Providers

    Eligible case management service providers must be employed by a county or under contract with a county agency or tribe to provide MH-TCM services and be:

  • • Case management mentors
  • • Case management supervisors
  • • Case manager associates (CMAs)
  • • Case managers
  • • Immigrant case managers
  • A case management mentor is a qualified, practicing case manager or case manager supervisor who teaches or advises and provides intensive training and clinical supervision to one or more case manager associates.

    A case management supervisor must be a mental health professional.

    A case manager associate (CMA) must be at least 21 years of age, have at least a high school diploma or its equivalent, work under the direction of a case manager or case management supervisor and:

  • • Have an associate of arts degree in one of the behavioral sciences or human services;
  • • Be a RN without bachelor’s degree;
  • • Within the previous 10 years, had:
  • • Three years life experience with SPMI; or
  • • SED as a child; or
  • • Three years life experience as a primary caregiver to an adult with SPMI, if providing case management to adults; or three years life experience as a primary caregiver to a child with SED if providing case management to children;
  • • Have 6,000 hours work experience as a state hospital technician (no degree); or
  • • Be a mental health practitioner.
  • CMAs may qualify as a case manager after four years of supervised work experience as a CMA.

    Mental health practitioners may qualify as a case manager after 3 years of supervised experience as a CMA.

    A case manager must have a bachelor’s degree in one of the behavioral sciences or related fields, including but not limited to social work, psychology, or nursing from an accredited college or university; or, if without a degree, must:

  • • Have three or four years experience as a case manager associate;
  • • Be a registered nurse without a bachelor’s degree and have a combination of specialized training in psychiatry and work experience consisting of community interaction and involvement or community discharge planning in a mental health setting totaling three years; or
  • • Be a person who qualified as a case manager under the 1998 DHS waiver provision and meet the continuing education and mentoring requirements.
  • An immigrant case manager, who does not meet the qualifications as stated above, may provide case management services to recipients with SPMI or SED who are immigrants if he/she is a member of the same ethnic group as the recipient and:

  • • Is currently enrolled in and actively pursuing credits to complete a bachelor’s degree in one of the behavioral sciences or related field from an accredited college or university;
  • • Completes 40 training approved by DHS in case management skills and in the characteristics and needs of adults with SPMI or children with SED; and
  • • Receives clinical supervision at least once per week until the requirements of obtaining a bachelor’s degree and 2,000 hours of supervised experience are met.
  • Case Manager Supervision and Continuing Education Requirements

    Case manager with 2000 hours or more supervised experience in the delivery of mental health services must receive 38 hours per year of ongoing supervision and clinical supervision.

  • • At least one hour per month must be under clinical supervision in individual service delivery with a case management supervisor.
  • • The remaining 26 hours of clinical supervision may be provided by a case manager with two years of experience.
  • Case manager without 2000 hours of supervised experience in delivery of mental health services must receive:

  • • 40 hours training approved by DHS in case management skills and in the characteristics and needs of adults with SPMI or children with SED; and
  • • One hour per week of clinical supervision in individual service delivery from a mental health professional until 2000 hours experience are met.
  • A case manager who is not licensed, registered, or certified by a health-related licensing board must receive 30 hours continuing education and training in mental illness and mental health services every two years.

    Group supervision may not constitute more than one-half of the required supervision hours.

    Clinical supervision related to a recipient must be documented in the recipient’s record.

    CMA Supervision and Continuing Education Requirements

    CMAs must:

  • • Receive 40 hours training approved by DHS in case management skills and in the characteristics and needs of adults with SPMI or children with SED;
  • • Annually receive at least 40 hours of continuing education in SMPI/SED and mental health; and
  • • Receive at least five hours of mentoring per week from a case management mentor, of which at least two hours must be individual and face-to-face.
  • County or County-Contracted Vendors

    Counties that are not the recipient’s county of financial responsibility or county-contracted vendors must:

  • • Obtain authorization from the county of financial responsibility before providing MH-TCM services; and
  • • Submit a copy of the contract (or relevant parts) to MHCP Provider Enrollment for each contract period.
  • MHCP will not reimburse MH-TCM services after a contract expiration date.

    Eligible MH-TCM Recipients

    Recipients eligible to receive MH-TCM services must:

  • • Be eligible for MA;
  • • Have a current diagnostic assessment and a diagnosis of:
  • • SPMI if an adult; or
  • • SED if a child under age 18 years;
  • • Be determined, or re-determined every 36 months, eligible for MH-TCM by a county or tribal government, based on a diagnostic assessment; and
  • • Be referred for MH-TCM services (with or without the recipient’s consent) by a:
  • • Physician;
  • • Mental health provider;
  • • Family member;
  • • Social worker employed by or under contract with the county;
  • • Legal representative;
  • • Other interested persons; or
  • • Self (self-referral).
  • If the recipient has not had a diagnostic assessment within 180 days, obtain a new diagnostic assessment within 10 days of receiving the referral for MH-TCM services.

    MH-TCM Covered Services

    Case management services include conducting a functional assessment, developing an ICSP/IFSCP, assisting the recipient in obtaining needed mental health and other services, ensuring the coordination of services, and monitoring and evaluating the delivery of services.

    Case management services can be any of the following activities:

  • • Developing and reviewing the recipient’s ICSP/IFCSP based on the functional and diagnostic assessments, and incorporating the ITP;
  • • Monitoring the discharge planning for a recipient leaving residential treatment facility, regional treatment center, or inpatient hospital;
  • • Assisting a recipient in obtaining health coverage for covered medical services;
  • • Arranging for transportation, lodging, meals, or child care needed for a recipient to access services;
  • • Assessing and evaluating the effectiveness of services received by a recipient;
  • • All planning, assessing, record keeping and documenting associated with the service coordination of a case;
  • • Receiving clinical supervision for an identified recipient with SPMI or SED;
  • • Routine contacting and other monitoring or communicating with the recipient, family members, or other relevant persons about the status of the recipient, the individual service plan or progress in achieving the goals of the service plan;
  • • Developing goals, service plans, written service agreement and routine case supervisory activities;
  • • Participating in case conferences, administrative reviews, recipient staffing and informal conferences;
  • • Completing and regularly reviewing the written functional assessment;
  • • Assisting a recipient in obtaining needed services;
  • • Coordinating with other agencies to obtain services for recipients.
  • Non-covered MH-TCM Services

  • • Treatment or therapy
  • • Legal advocacy
  • • Performing a diagnostic assessment
  • • Administration, management, or monitoring medications
  • Coordinate Case Management Services

    Ask each recipient about other services he/she is receiving, including case management or service coordination. Occasionally, a recipient may need MH-TCM services from another agency or program, or be assigned a case manager by the other agency or program, for example, when:

  • • A civil commitment exists;
  • • The recipient receives child welfare or waivered services;
  • • The recipient has been diagnosed with mental retardation or a related condition and mental illness/SED; or
  • • The recipients was assessed as chemically dependent and diagnosed with mental illness/SED.
  • The different agencies or programs must:

  • • Notify each other of the case management services;
  • • Coordinate services;
  • • Designate a primary case manager, by mutual consent of the client, family, tribal government and county.
  • The recipient’s treatment plan must contain clear documentation of:

  • • The circumstances that necessitate each case management service;
  • • Specific case manager roles and responsibilities, including, for each type of service, who will:
  • • Coordinate;
  • • Assure access; and
  • • Monitor;
  • • Frequency of contact between case managers for the purpose of coordinating services;
  • • Services the recipient needs.
  • MH-TCM Billing

    MH-TCM is reimbursed on a monthly basis to all but tribal providers when a contact is made with an eligible recipient.

  • • Team Case Managers: If a team that includes case managers from a county, a contracted vendor, and a tribe provide MH-TCM, each agency may receive payment for MH-TCM provided to the same recipient in the same month. To bill for case management across disciplines (e.g., CW-TCM or waivered service) providers must apply all documentation, coordination of care, and other requirements according to each discipline.
  • MH-TMC and ACT: MHCP will reimburse MH-TCM and ACT provided concurrently only during the month of admission to or discharge from ACT services. To receive MH-TCM reimbursement for the month of admission, the county, tribe, or county vendor must:
  • • Add modifier 99 to the line item and enter the ACT admission date in the “comments” field
  • MH-TCM and ARMHS: MHCP will not reimburse MH-TCM and ARMHS services unless activities are separate, clearly defined and documented, and billed accordingly. For example, a linking or coordinating activity cannot be considered MH-TCM in some circumstances and ARMHS in other circumstances.
  • MH-TCM and RSC: Relocation Service Coordination (RSC) is a case management service available to recipients in a facility (nursing facility, ICF-MR/RC, or inpatient hospital). RSC and MH-TCM cannot be provided in the same month to the same recipient. Counties may elect to provide only one of these services.
  • MH-TCM and IMD: MHCP reimbursement for MH-TCM may be available for individuals covered by major program IM.
  • MH-TCM and IRTS: MHCP will reimburse MH-TCM and IRTS services when provided concurrently.
  • MH-TCM and Diagnostic Assessment: MH-TCM is available to recipients before a diagnostic assessment is completed when all of the following conditions are met:
  • • The recipient is referred for and accepts case management services;
  • • At the time of referral, the recipient refuses to obtain a diagnostic assessment for reasons related to his/her mental illness or a child's parent refuses to obtain a diagnostic assessment for the child;
  • The case manager determines the recipient is eligible for MH-TCM services; and
  • • The recipient obtains a new or updated diagnostic assessment, resulting in SED or SPMI, within four months of the first day MH-TCM services began.

    Do not bill MH-TCM services until after the case manager receives a completed diagnostic assessment.
  • MH-TCM and IHS/638: MHCP will reimburse an IHS/638 only for face-to-face MH-TCM services, when the IHS/638 bills according to its billing procedures.
  • MH-TCM Billing Procedures

    Bill MH-TCM services online using MN–ITS 837P
    Counties and county-contracted vendors: Bill one claim per month.
    Tribes and FQHCs: Bill one claim per encounter. Enter the date of service.
    Do not enter a treating provider NPI number on each line item.

    For an adult recipient, a face-to-face contact is required in at least one month out of a quarter. MH-TCM claims will deny when a face-to-face contact occurs within the preceding two months prior to a change in eligibility status and the first contact under the new eligibility status is a telephone contact. Providers must resubmit the claim with case notes documenting the face-to-face contact using the AUC cover sheet.

    Mental Health Targeted Case Management Benefits

    Proc Code

    Modifier

    Brief Description

    Service Limitations

    T2023

    HE HA*

    Face-to-face contact between case manager and recipient under age 18 years

    1 unit per month

    HE*

    Face-to-face contact between case manager and recipient age 18 years or older

    HE U4*

    Telephone contact (recipient age 18 years or older)

    T1017
    For IHS/638 and FQHC billing only

    HE HA

    Face-to-face encounter (child under 18)

    Per encounter

    HE

    Face-to-face encounter (adult 18 and over)


    Legal References

    MS 245.461 to 245.468 Minnesota Comprehensive Adult Mental Health Act
    MS 245.462 Definitions
    MS 256B.0625, subd. 20 Mental Health Case Management
    MS 245.487 to 245.4887 Minnesota Comprehensive Children’s Mental Health Act
    Minnesota Rules 9505.0322 Mental Health Case Management Services
    Minnesota Rules 9520.0900 to 9520.0926 Case management services for children

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