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Hospital In-reach Service Coordination (IRSC)

Revised: 11-25-2014

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Billing
  • Legal References
  • Hospital Services Home Page
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    Overview

    Effective January 1, 2012, MHCP covers hospital in-reach service coordination (IRSC) to reduce instances of emergency department (ED) and other non-medically necessary health care use. Hospital IRSC brings together health care and community-based services for MHCP recipients for up to 60 days after hospital discharge. It includes helping recipients find services to address dental, mental and chemical health, housing, transportation, employment, peer support services, and other health, social and economic needs. IRSC can connect the recipient with existing covered services available to them, such as targeted or waiver case management, or care coordination in a health care home.

    Eligible Providers

    Hospitals may employ or contract with the following individual providers or community-based providers to provide hospital IRSC:

  • • Clinical nurse specialist, mental health specialty (CNS MH)
  • • Licensed independent clinical social worker (LICSW)
  • • Licensed marriage and family therapist (LMFT)
  • • Licensed professional clinical counselor (LPCC)
  • • Licensed psychologist (LP)
  • • Nurse practitioner
  • • Physician
  • • Physician assistant (PA)
  • Enrolled Community-Based Providers

    MHCP enrolled community-based providers need to sign and submit to MHCP a Community-based Providers for In-Reach Service Coordination (IRSC) – Applicant Assurance Statement (DHS-3898) so their records indicate they are IRSC program participants.

    In-Reach Service Coordinators

    Eligible in-reach service coordinators must hold a minimum of a bachelor’s degree in social work, public health, corrections or a related field.

    Eligible Recipients

    Before performing the assessment, MHCP recommends that providers determine if the recipient is already receiving services that would make them ineligible for participation in in-reach care coordination.

    Recipients receiving the following services are not eligible for participation:

  • • Health care homes
  • • Mental health targeted case management
  • • A health care delivery system (HCDS) demonstration project
  • IRSC is available to recipients of any age with three or more emergency department (ED) visits in the previous four consecutive months.

    The qualifying ED services and inpatient stays are not limited to a single hospital. Clinicians may use the MN–ITS Health Information Request (HIR) User Guide clinical tool to access a more complete medical history for MHCP recipients. The HIR User Guide clinical tool can help prevent duplication of services. If multiple providers deliver IRSC one or more days during a 60-day service period, MHCP will reimburse all providers for the initial assessment; however, only the provider whose claim is filed first with the state will be reimbursed for the follow-up continuing service.

    Children Diagnosed with Severe Emotional Disturbance (SED)

    Recipients under the age of 21 who are diagnosed with SED are eligible for IRSC services if they meet one of the following criteria:

  • • Have visited a hospital emergency department two or more times in the previous consecutive three months
  • • Are admitted to an inpatient psychiatric unit two or more times in the previous consecutive four months
  • • Are being discharged from either an ED or an inpatient psychiatric unit to a shelter
  • Recipients enrolled in the following MHCP programs are eligible for hospital IRSC services:

    BB

    FF


    JJ


    LL

    MA

    NM

    RM

    MinnesotaCare Plus One

    MinnesotaCare Basic Plus
    MinnesotaCare Basic Plus Two

    MinnesotaCare Basic Plus
    MinnesotaCare Basic Plus Two

    MinnesotaCare Expanded

    Medical Assistance

    State-funded Medical Assistance

    Refugee

    Recipients enrolled in the following programs are not eligible for MHCP hospital IRSC services:

    AC

    EH

    FP

    HH

    IM

    QM

    Alternative Care

    Emergency Medical Assistance (except for pending appeals)

    Family Planning

    HIV/AIDS

    Institution for Mental Disease

    Qualified Medicare Beneficiary

    Covered Services

    MHCP covers hospital IRSC performed through a hospital ED. This includes working with other providers to connect eligible recipients with existing MHCP covered services, community-based services and other resources available to them.

    The provider must perform an initial assessment of the recipient to evaluate:

  • • Mental and chemical health needs
  • • Housing needs
  • • Transportation needs
  • • Employment needs
  • • Family or peer support services needs
  • • Other health, dental, social, educational, and economic needs, including an assessment of other services for which the recipient may be eligible or receiving, such as targeted or waiver case management, or care coordination in a health care home
  • Follow-up services after the initial assessment include working with other providers to coordinate services to help the recipient access a variety of services. Services under IRSC focus on reducing the number of visits to a hospital ED or inpatient readmissions for non-medically necessary health care. These services must address the recipient’s needs determined in the initial assessment. Services may be provided in the recipient’s living environment or by phone.

    Hospital IRSC may be provided for up to 60 days from the discharge date of the ED visit or of the inpatient hospital stay that resulted from an ED visit and is:

  • • Limited to two non-overlapping 60-day periods per calendar year, if there are a minimum of three or more ED visits or inpatient admitting events that resulted from an ED visit in the previous consecutive months
  • • Limited to a total of 80 hours across one or both 60-day periods
  • Reimbursement Period

  • The 60 day service reimbursement period begins:
  • • On the date of the initial assessment for recipients identified in the emergency department
  • • On the date of discharge from the hospital for recipients identified during their hospitalization
  • Noncovered Services

    The following services are not covered under hospital IRSC:

  • • Services for more than 80 hours within a calendar year
  • • More than two nonoverlapping 60-day occurrences within a calendar year
  • • Other existing covered services (for example, transportation, housing, mental and chemical health services)
  • Billing

  • • Use the electronic 837P Professional claim format
  • • Use procedure code T1016 with modifier U2 for the initial hospital IRSC assessment
  • • Use procedure code T1016 with modifier U2 and TS for follow-up hospital IRSC services
  • • Services are billable in 15-minute unit increments
  • • Use the hospital NPI as the billing provider
  • • Report the NPI of the treating professional; if the services are provided by an in-reach service coordinator, report the NPI of the supervising professional as the treating provider
  • Managed Care Organizations (MCOs)

    Submit claims for MCO enrollees to the appropriate prepaid MCO.

    Past Timely Filing Claims

  • Submit claims over one year from the date of service with a copy of the provider update Hospital In-reach Service Coordination (IRSC) (MHP-13-07) using an Electronic Claim Attachment AUC Cover Sheet for Health Care Claims form.
  • Legal References

    Minnesota Statute 256B.0625, subd. 56 Covered Services; Medical service coordination

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    © 2017 Minnesota Department of Human Services Updated: 11/25/14 11:00 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 11/25/14 11:00 AM