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School districts must choose from one of three options under Children’s Therapeutic Services and Supports (CTSS) for billing Individualized Education Program (IEP) health-related mental health services based on what best fits their needs. CTSS is one of the rehabilitative mental health packages covered by Minnesota Health Care Programs (MHCP). CTSS establishes policies and practices for certification and coverage of mental health services for children who require varying therapeutic and rehabilitative levels of intervention. The three CTSS options are IEP evaluations, contract CTSS and school CTSS.
The spectrum of services available under CTSS allows providers to address the conditions of emotional disturbance that impair and interfere with children’s abilities to function. These rehabilitative services offer a broad range of medical and remedial services and skills to restore a child’s functional abilities as much as possible.
Schools choosing option 1, IEP evaluations, may only submit claims for IEP evaluations. CTSS services require the district to choose, submit an application and receive approval for either option 2, contract CTSS, or option 3, school CTSS, certification.
To bill MHCP for the federal share of covered IEP mental health related services, districts and tribal schools must be actively enrolled with MHCP and have been approved for one of the CTSS certification options.
To enroll with MHCP, review the IEP Providers section of this manual for information and forms under MHCP Provider Enrollment.
Before beginning the CTSS application process, review the documents below, and all of the information in this section. The overview document provides more details to help the district choose the option that best fits the desires of the district. Select an option, then complete and submit the application (and any supporting documentation) to the Department of Human Services (DHS) for approval. Use the CTSS School Primary Certification Guide to ensure policies and procedures meet the minimum standards.
Note: The effective date of certification can be no earlier than the date DHS receives the application.
Choose from one of the following options. Choosing an option does not lock in that option permanently. Districts may apply for a different option at any time.
Option 1: IEP Evaluations
Option 2: Contract CTSS
Option 3: School CTSS
Complete and submit to DHS the School CTSS Application.
Complete and submit the School CTSS Application with executed contract(s). Receive DHS approval before billing services.
Complete the School District CTSS Application with necessary attachments. Submit model case file after part I is approved. Receive DHS approval before billing services.
Note: Districts can submit required documents for option 1 and begin billing while awaiting CTSS certification for options 2 and 3.
The number of CTSS applications depends on the Annual Special Education Application submitted to Minnesota Department of Education (MDE). Billing and reimbursement for CTSS services provided to children who have services included on an Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP) must be consistent with MDE Electronic Data Reporting System (EDRS) reporting requirements
Beginning July 1, 2012, the district that provides the service must report the data to DHS and MDE
Eligible service providers working within their scope of practice and who are either employed by or contracted by the district must provide IEP mental health services.
Unlicensed mental health practitioners and mental health behavioral aids must meet pre-service, continuing education requirements and be under the clinical supervision of an MHP.
Mental Health Practitioner: a person who meets at least one of these qualifications:
Mental Health Behavioral Aide (MHBA): A paraprofessional, who is not the legal guardian or foster parent of the child, who is working to implement mental health services identified in a child’s IEP or IFSP, individual treatment plan and individual behavior plan. The MHBA must be under both the clinical supervision of an MHP and the direction of either an MHP or a mental health practitioner who is under the clinical supervision of an MHP. The mental health professional or practitioner must be employed by a CTSS certified agency or district. The MHBA must qualify under either Level I or Level II criteria, as listed below.
Level I MHBA:
Level II MHBA:
Continuing education: Mental health practitioners and MHBAs complete 20 hours of continuing education every two calendar years. Topics covered are included in Minnesota Rules, part 9535.4068, subp. 2.
Children qualify for CTSS by a standard or extended diagnostic assessment (DA) that identifies a mental health disorder and meeting either emotional disturbance (ED) or severe emotional disturbance (SED) criteria.
In addition to the basic eligibility requirements, the following age requirements apply to CTSS service:
Review the information in Basics for All IEP Services of the MHCP Eligible Children section of this manual for an overview of eligible children.
Refer to the information in the Basics for All IEP Services subsection in the Covered and Noncovered Services section of this manual.
IEP evaluations covered under mental health services are provided by a mental health professional or school psychologist, are health-related and result in an IEP or IFSP with covered IEP services or determine the need for continued services.
IEP evaluations include:
IEP evaluation activities include:
Note: Meetings to discuss evaluation results or make recommendations are not covered.
DHS does not publish or maintain a list of covered tests. Refer to Buros’ Mental Measurement Yearbook, most recent edition, for covered assessments.
IEP evaluations are billed under the same NPI number as other IEP services. Service providers do not enroll separately.
Bill IEP evaluations only if the evaluation results in the child receiving services or continuing to receive services.
Refer the child to a mental health professional for mental health diagnostic assessment and treatment if any concerns exist about mental illness or emotional disturbance.
Diagnostic Assessment (DA)
Providers must complete a standard or extended DA within one year before beginning CTSS services. CTSS services cannot begin or continue without a current DA. Only qualified MHP or clinical trainees can conduct the DA.
Include in the DA:
Minnesota Rule 9505.0370-9505.0372 requires a written assessment that documents a clinical and functional face-to-face evaluation of the client’s mental health including the nature, severity, impact of behavioral difficulties, functional impairment and subjective distress of the client, and identifies strengths and resources.
A licensed psychologist with competence in psychological testing as reported to the Board of Psychology provides psychological testing. Psychological tests and other psychometric instruments are used to determine the status of the child’s mental, intellectual and emotional functioning. DHS does not publish nor maintain a list of covered tests. Refer to Buros’ Mental Measurement Yearbook, most recent edition.
Note: See billing section of school options for billing DA and psychological testing.
Schools may choose which of the following CTSS services to certify.
A planned and structured face-to-face treatment of a diagnosed mental illness through the psychological, psychiatric or interpersonal method most appropriate to the child’s needs as identified by the current diagnostic assessment. Psychotherapy is:
Note: Individual and group psychotherapy cannot be provided concurrently with interactive individual or interactive group psychotherapy.
Unlike a thought, feeling or perception, other people can observe a skill. A person must practice a skill to master and maintain it, including right ways and wrong ways to perform the skill. Typically, a person performs a skill for a reason and can generalize and adapt the skill to many different situations.
An MHP, or a mental health practitioner who is under the clinical supervision of an MHP, provides skills training designed to help the child develop psychosocial skills. These are skills that are medically necessary to rehabilitate the child to an age-appropriate developmental trajectory that has been disrupted by a psychiatric illness. Skills training may also be delivered to help the child self-monitor, compensate for, cope with, counteract or replace skill deficits or maladaptive skills acquired during the course of a psychiatric illness.
Skills training is subject to the following requirements:
Crisis assistance recognizes factors that may bring on a mental health crisis, identifies behaviors related to the crisis, and provides information about resources to resolve the crisis.
Crisis assistance is the development of a plan that identifies triggers and ways to decrease crisis behaviors that is intense, time-limited and designed to resolve or stabilize a crisis through arrangements for direct intervention and support services to the child and family.
Crisis assistance is for the child, child’s family and all of the child’s service providers.
A mental health professional or mental health practitioner develops a crisis plan and a mental health professional reviews and approves it. The plan is implemented in a crisis situation and addresses prevention and intervention strategies that include: arranging admission to acute care hospital inpatient treatment, crisis placement and community resources for follow-up and emotional support to the family during crisis.
The crisis plan must use resources designed to address abrupt or substantial changes in the child’s and family’s functioning as shown by a sudden change in behavior with negative consequences for well-being, loss of usual coping mechanisms or presentation of danger to self or others.
Mental Health Behavioral Aide (MHBA) Services
MHBA services are designed to provide medically necessary services to improve the child’s functioning in the progressive use of developmentally appropriate psychosocial skills. Activities include working directly with the child, child-peer groupings, or child-family groupings to practice, repeat, reintroduce and master the skills as previously taught by a mental health professional or mental health practitioner.
Individual Behavior Plan (IBP)
In addition to the IEP or IFSP, an IBP is required to provide specific service delivery instructions to the MHBA. It outlines the MHBA’s responsibilities in helping the child to achieve treatment outcomes. Mental health professionals must approve the services in the IBP before the MHBA provides the services. The IBP must include:
The IBP is related to reinforcing the goals and objectives of the Individual Treatment Plan (ITP) based on the diagnostic assessment, and should specify the services the MHBA is to provide to help reduce a child's symptoms and increase function. An IBP is not a behavior management plan.
MHBA services are provided by a mental health behavioral aide who meets all qualifications, training and orientation requirements for an MHBA and who is under the clinical supervision and direction of an MHP. A mental health practitioner who is under the clinical supervision of an MHP may also provide MHBA services.
MHBA activities include:
Direction of MHBA services
Direction of the MHBA services means assuring that services are provided in a manner determined necessary and appropriate by a mental health professional or a mental health practitioner who is under the clinical supervision of the mental health professional. Direction should provide a balance of initial coaching (for those MHBAs who lack skills and experience) and a minimum amount of intrusion in the therapeutic process and include:
Mental health professionals and practitioners must review and approve by co-signing progress notes prepared by the MHBA for accuracy and consistency with diagnostic assessment, treatment plan and behavior goals at least every 30 days.
Service Plan development covers two separately-billable activities:
Only certified option 2 or 3 CTSS or their contracted community provider may include the time spent in administering and reporting standardized outcomes and measurements as part of an evaluation (T1018 U4), and the development and review of the treatment plan as part of the service (T1018 U4 HE).
Note: The contracted CTSS provider and the school district must decide and note in their contract whether the CTSS provider or the school will submit the claim and report the activity for reimbursement.
Review the Record Keeping and Documentation section for an overview of the basic IEP record keeping, documentation service time and encounter reporting requirements.
In addition to the general documentation requirements, mental health documentation must include the following in progress notes:
Review the information in Basics for All IEP Services subsection of the Covered and Noncovered Services section of this manual.
Submit claims using the 837P Professional claim type. Refer to the MN–ITS IEP User Guide for step-by-step instructions for direct data entry claims. Batch billers submitting X12 837P claims, may review the MHCP 5010/D.0 Compliance web page and the AUC Minnesota Uniform Companion Guide for transaction guideline.
Refer to the IEP Billing and Authorization Requirements section of this manual for billing requirements.
IEP Mental Health CTSS Definitions and Acronyms
IEP Definitions and Acronyms
Minnesota Statutes 245.461 to 245.468 (Minnesota Comprehensive Adult Mental Health Act)
Minnesota Statutes 245.462 (Definitions)
Minnesota Statutes 256B.0625, subd. 26 (2013 Minnesota Statue: Covered Services – Special Education)