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CTSS Children’s Day Treatment

Revised: 11-30-2018

  • Overview
  • Eligible Providers
  • Entity Certification
  • Clinical Supervision
  • Eligible CTSS Children’s Day Treatment Providers
  • Eligible Recipients
  • Covered Services
  • Documentation Requirements
  • Noncovered Services
  • Authorization
  • Billing
  • Overview

    Children’s therapeutic services and supports (CTSS) for children’s day treatment is a site-based, structured mental health treatment program. It consists of psychotherapy and skills training services.

    Day treatment services:

  • • A multidisciplinary team Provides the services under the clinical supervision of a mental health professional
  • • Services are available twelve months of the year
  • • Stabilize the child’s mental health status
  • • Develop and improve the child’s independent living and socialization skills
  • • Provide training to enable the child to live in the community
  • • Services are not part of inpatient or residential treatment services
  • Eligible Providers

    Entity Certification

    Children’s and adult day treatment services have different certifications, standards and limitations.

    Certified entities include:

  • • Licensed outpatient hospitals with JCAHO accreditation
  • • MHCP enrolled community mental health centers
  • • County –operated entity certified by the state; or
  • • A non-county entity certified by the state
  • • IHS/638 facilities
  • • Children’s day treatment providers, including school districts (certified under option 2 or 3), must submit an application and receive certification under CTSS
  • Programs must provide adequate staffing and facilities to do the following:

  • • Promote recipient health
  • • Ensure a safe environment
  • • Protect recipient rights
  • • Implement each recipient’s individual treatment plan (ITP)
  • Clinical Supervision

    For children’s day treatment programs, the supervisor must do the following:

  • • Be a licensed and MHCP enrolled mental health professional
  • • Be present and available on the premises more than 50 percent of the time, in a five-working-day period, when the mental health practitioner is providing a mental health service
  • • Approve and sign the recipient's diagnosis, ITP and any change to either
  • • Review and sign the recipient’s record, every 30 days, indicating the recipient’s services for the previous 30 day period were reviewed and remain appropriate for the recipient’s condition
  • • Be available for urgent consultation as required by the recipient’s needs or situation
  • Clinical supervision may occur individually or in a group setting to discuss treatment and review progress toward goals. Note: a clinical trainee must receive clinical supervision in accordance with clinical supervision requirements specified in 9505.0371 - Minnesota Administrative Rules.

    Eligible CTSS Children’s Day Treatment Providers

  • Mental health practitioner
  • Mental health professional
  • Eligible Recipients

    Eligible recipients for CTSS children’s day treatment meet the following:

  • • Under age 18 and diagnosed with an emotional disturbance (ED) or meet severe emotional disturbance (SED) criteria
  • • Between ages 18 and 21 and diagnosed with a mental illness (MI) or meet serious and persistent mental illness (SPMI) criteria
  • • Need the intensity level of day treatment as identified in the diagnostic assessment
  • Recipients admitted to children’s day treatment must be in need of and have the capacity to understand and benefit from the rehabilitative nature, structured setting and therapeutic components of the program’s psychotherapy and skills activities. Recipients who do not have, or cease to have, the cognitive capacity to benefit from day treatment services, may benefit from day habilitation or other services under a waiver program. Refer recipients in need of other services to the county human service agency, school or private agencies.

    Recipients enrolled in a managed care organization must receive day treatment services through the managed care organization, which may have different coverage and authorization requirements.

    Covered Services

    Day treatment is distinguished from day care by the structured therapeutic program that uses CTSS service components which include:

  • • Psychotherapy - provided by a mental health professional or a mental health practitioner qualified as a clinical trainee
  • • Skills training - individual or group, provided by a mental health professional or mental health practitioner
  • The day treatment program must be available:

  • • No less than:
  • • One day per week
  • • Two hours per day
  • • No more than:
  • • Three hours per day
  • • 15 hours per week
  • • As described in the recipient’s ITP
  • Per available day, psychotherapy must be provided:

  • • No less than one hour
  • • No more than 2 hours, with the remaining time including skills training
  • Interactive children’s day treatment may use physical aids and nonverbal communication to overcome communication barriers because the recipient demonstrates one of the following:

  • • Has lost or has not yet developed either the expressive language communication skills to explain his or her symptoms and response to treatment
  • • Does not possess the receptive communication skills needed to understand the mental health professional if he or she were to use adult language for communication
  • • Needs an interpreter, whether due to hearing impairment or because the recipient’s language is not the same as the provider’s language
  • Documentation Requirements

    Document the provision of each of the service components. You may use a daily checklist with the services summarized weekly. A checklist must show all of the following:

  • • Date of service
  • Session start and stop times
  • • Service provided (skills training, psychotherapy)
  • • Who provided the service
  • • ITP goal(s) worked on
  • • Outcomes of the service compared to baselines and objectives toward ITP goals
  • • Name, dated signature, and credential of the person who delivered the service
  • • If applicable, co-signature of supervisor
  • • Name and date of each contact made with other persons interested in the client, including representative of the courts, corrections systems, or schools.
  • • Name and date of any contact made with the client’s other mental health providers, case manager, family members, primary caregiver, legal representative, or the reason the provider did not contact the client’s family members, primary caregiver, or legal representative if applicable.
  • Noncovered Services

    CTSS day treatment does not cover mental health behavioral aide (MHBA) services. MHBAs are not an eligible provider of CTSS day treatment services. Other noncovered services include:

  • • Service components of CTSS simultaneously provided by more than one provider unless prior authorization is obtained
  • • Treatment by multiple providers within the same agency at the same clock time
  • • Children's therapeutic services and supports provided in violation of Medical Assistance policy in Minnesota Rules (part 9505.0220)
  • • Mental health behavioral aide services provided by a personal care assistant who is not qualified as a mental health behavioral aide and employed by a certified children's therapeutic services and supports provider
  • • Service components of CTSS that are the responsibility of a residential or program license holder, including foster care providers under the terms of a service agreement or administrative rules governing licensure
  • • Additional activities that may be offered by a provider but are not otherwise covered by Medical Assistance, including:
  • • A service that is primarily recreation oriented or that is provided in a setting that is not medically supervised. This includes sports activities, exercise groups, activities such as craft hours, leisure time, social hours, meal or snack time, trips to community activities and tours
  • • A social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's emotional disturbance
  • • Prevention or education programs provided to the community
  • • Treatment for clients with primary diagnoses of alcohol or other drug abuse
  • Authorization

    Refer to Authorization for general authorization policy and procedures. For CTSS day treatment services, authorization is required in the following situations:

  • • To exceed 150 hours per calendar year (separate from CTSS 200 hour limit)
  • • When there is a need to provide day treatment services concurrent with other services
  • Billing

  • • Bill children’s day treatment services online using MN–ITS 837P
  • • Enter the treating provider NPI number on each claim line
  • • Use procedure code H2012
  • • Use modifier HK to indicate children’s day treatment
  • • Use modifier UA to indicate CTSS
  • CTSS Children’s Day Treatment








    Behavioral Health Day Treatment

    1 hour

    Daily limit – minimum 2 hours, maximum 3 hours (may not obtain authorization for more day treatment hours in a day)

    Weekly limit - maximum 15 hours per week (may not obtain authorization for more day treatment hours in a week)

    Calendar year threshold – maximum 150 hours per calendar year without authorization



    Behavioral Health Day Treatment (interactive)

    1 hour

    Daily limit – minimum 2 hours, maximum 3 hours (may not obtain authorization for more day treatment hours in a day)

    Weekly limit - maximum 15 hours per week (may not obtain authorization for more day treatment hours in a week)

    Calendar year threshold – maximum 150 hours per calendar year without authorization

    Legal References

    Minnesota Statutes 256B.0943 CTSS
    Minnesota Rules 9535.4068
    Continuing education for practitioner
    Minnesota Rules 9505.0370
    , 9505.0371, 9505.3072 Outpatient Mental Health Services

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