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Mental Health Services

Revised: 07-13-2017

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Overview

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.

Eligible Providers

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.

CTSS Certification

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.

  • CTSS Overview for Schools and School Districts (DHS-4982B-ENG) (PDF)
  • CTSS School Primary Certification Guide – Policies and Procedures (DHS-4982A-ENG) (PDF)
  • CTSS School Primary Certification Application Form (DHS-4982-ENG) (PDF)
  • 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.

    CTSS Options

    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.

    Cooperatives and Education Districts

    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

    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.

    Mental Health Professionals (MHP) – Licensed

  • • Licensed psychologist (LP) – Licensed under MS 148.89 to 148.98, stated competencies to the Board of Psychology in the diagnosis and treatment of mental illness
  • • Licensed independent clinical social worker (LICSW) – Licensed under MS 148E.001-148E.290
  • • Clinical nurse specialist (CNS) – Registered nurse licensed by the MN Board of Nursing under MS 148.171-148.285 and certified as a clinical nurse specialist in psychiatric or mental health nursing
  • • Psychiatric nurse practitioner (NP) – Must meet both of the following:
  • • Advanced practice nurse licensed to practice according to the Minnesota Board of Nursing as a registered nurse licensed under MS 148.171– 48.285
  • • Certified as a nurse practitioner in family psychiatric or mental health nursing by a national nurse certification organization
  • Psychiatrist – Physician licensed under MS chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible for board certification in psychiatry
  • • Licensed marriage and family therapist (LMFT) - Licensed under MS 148B.29 to 148B.39 with at least two years of post-master’s experience under clinical supervision in the delivery of psychiatric or mental health services to children with emotional disturbances
  • • Licensed professional clinical counselor (LPCC) – Licensed under MS 148B.5301 including at least 4,000 hours of postmaster’s supervised experience in the delivery of clinical services in the treatment of mental health disorders or emotional disturbance
  • Mental Health Practitioners and Behavioral Aids – Unlicensed

    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:

  • • Clinical trainee meeting one of the following criteria under clinical supervision MR 9505.0371 sub 4. of an MHP:
  • • School psychologist - Licensed by the Board of Teaching.
  • • Licensed graduate social worker (LGSW) - Licensed by the Board of Social Work under MS 148E.001-148E.290.
  • • Licensed independent social worker (LISW) - Licensed by the Board of Social Work under MS 148E.001-148E.290.
  • • Holds a bachelor’s degree in one of the behavioral sciences or related fields from an accredited college or university and has 2,000 hours of supervised clinical experience in the delivery of clinical services in the treatment of mental illness to children with emotional disturbances
  • • Has completed 6,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness
  • • Is enrolled as a graduate student in one of the behavioral sciences or related fields and is formally assigned to the center for clinical training by an accredited college or university
  • • Holds a master’s or other graduate degree in one of the behavioral sciences or related fields from an accredited college or university
  • 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:

  • • Must be at least 18 years old; have a high school diploma, general equivalency diploma (GED) or, within the last ten years, two years of experience as a primary caregiver for a child with severe emotional disturbance; and meet orientation and training requirements
  • • Document orientation and training requirements for MHBA in the personnel record
  • • Must have 30 hours of pre-service training
  • • Must have 15 hours of face-to-face training in mental health services delivery on the following training topics:
  • • Minnesota data privacy law
  • • Minnesota Comprehensive Children’s Mental Health Act
  • • Diagnostic classifications of emotional disturbance
  • • Uses and potential side effects of psychotropic medications in children
  • • Core values and principles of the Child Adolescent Service System Program
  • • Coordination between the public education and the mental health systems
  • • Culturally appropriate services
  • • Services to children with developmental disabilities or other special needs
  • • Must have eight hours of parent team training on the following topics:
  • • Partnering with parents
  • • Fundamentals of family support
  • • Fundamentals of policy and decision-making
  • • Defining equal partnerships
  • • Complexities of parent and service provider partnership in multiple service delivery systems due to system strengths and weaknesses
  • • Sibling impacts
  • • Support networks
  • • Community resources
  • Level II MHBA:

  • • Must be at least 18 years old and have an associate or bachelor’s degree or 4,000 hours of experience in delivering clinical services in the treatment of mental illness for children or adolescents
  • • Must meet the orientation, training requirements, pre-service and continuing education requirements listed above for a Level 1 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.

    Eligible Recipients

    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:

  • • For children under age 18 to continue to receive CTSS services, obtain a new standard or extended DA annually.
  • • For children ages 18-20 to continue to receive CTSS services, a brief DA may substitute for the annual DA unless the child’s condition has changed significantly. A new DA is required if significant changes are found.
  • Review the information in Basics for All IEP Services of the MHCP Eligible Children section of this manual for an overview of eligible children.

    Covered Services

    Refer to the information in the Basics for All IEP Services subsection in the Covered and Noncovered Services section of this manual.

    Assessments and Evaluations

    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:

  • • Pre-IEP evaluations that result in an IEP or IFSP
  • • Ongoing assessments to determine progress or need for changes in services
  • • Reevaluations
  • IEP evaluation activities include:

  • • Administering face-to-face assessments
  • • Interpreting test results
  • • Writing reports
  • 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.

    Psychological Testing and Diagnostic Assessments

    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:

  • • An evaluation of the child’s current life situation
  • • The reason for the assessment
  • • The child’s needs based on the child’s baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities and safety needs
  • • A CD screen; assessment methods and use of standardized assessment tools; the clinical summary, recommendations and prioritization of needed mental health, ancillary or other services
  • • A five axes diagnosis
  • 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.

    Psychological Testing
    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.

    Children’s Therapeutic Service and Supports (CTSS) Services

    Schools may choose which of the following CTSS services to certify.

    Psychotherapy
    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:

  • • Directed toward change in an underlying mental health condition or disorder
  • • Designed to reduce the symptoms of a disorder and improve the effect of symptoms on the child’s functioning
  • • Provided to the child whose mental health issues diagnosed according to current community mental health standards
  • • Directed to goals and measurable objectives stated in the child’s Individual Treatment Plan (ITP) provided by an MHP or clinical trainee
  • Psychotherapy includes:

  • • Individual psychotherapy, including interactive individual psychotherapy, hypnotherapy (conducted by a mental health professional trained in hypnotherapy) and biofeedback training.
  • • Family psychotherapy for the child and one or more family members whose participation is necessary to accomplish the child’s treatment goals. Family members may be related by blood, marriage or adoption or may be foster parents, primary caregivers or significant others.
  • • Group psychotherapy, including interactive group psychotherapy provided by a mental health professional and 3-8 children, or two mental health professionals and 9-12 children who, because of the nature of their emotional, behavioral or social dysfunction, can derive mutual benefit from interaction in a group setting. This is why a class of students is not a group.
  • • Interactive psychotherapy using distinct diagnostic and medical psychotherapeutic procedures helped by physical aids and nonverbal communication to overcome barriers to the therapeutic interaction between the physician and child who:
  • • Lost or has not yet developed the expressive language communication skills to explain his or her symptoms and response to treatment
  • • Does not possess the receptive communication skills to understand the mental health professional if he or she were to use ordinary language for communication
  • • Multiple family group psychotherapy designed for at least three, but no more than five families, regardless of family members’ MCHP eligibility status or the number of family members who participate in the family session.
  • • Psychotherapy for crisis designed for a child who experiences acute social, interpersonal or environmental stress that threatens the child’s current level of adjustment or causes significant subjective distress.
  • Note: Individual and group psychotherapy cannot be provided concurrently with interactive individual or interactive group psychotherapy.

    Skills Training
    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:

  • • The child must always be present during the skills training; however, a brief absence of no more than ten percent of the session is allowed to instruct family members.
  • The training delivered to the child or family is targeted to the specific deficits or maladaptation’s of the child’s mental health disorder and must be prescribed in the child’s individual treatment plan.
  • • The training delivered to the child’s family must teach skills needed to enhance the child’s skill development and to help the child use the skills and develop or maintain a home environment that supports the child’s ongoing use of the skills.
  • • Group skills training may be provided to multiple participants who, because of the nature of their emotional, behavioral or social dysfunction, can get mutual benefit from interaction in a group setting: one professional or practitioner with a group of 4-8 participants; two professionals or practitioners or one professional and one practitioner with a group of 9-12 participants. This is why a classroom or class of students is not a group.
  • Crisis Assistance
    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:

  • • Detailed instructions on the services provided
  • • Time allocated for each service
  • • Methods of documenting the child’s behavior
  • • Methods of monitoring the child’s progress in reaching objectives
  • • Goals to increase or decrease targeted behaviors
  • 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 services must be medically necessary treatment services identified in the child’s IEP or IFSP, individual treatment plan and individual behavior plan.
  • • MHBA services are provided one-on-one to an eligible child in an appropriate setting or in a peer or family group. The MHBA practices with the child the skills taught to the child by the mental health professional or mental health practitioner. The MHBA does not change or teach the child new skills or practice skills that are not previously taught by the mental health professional or mental health practitioner. The MHBA does not write the IBP but rather carries out the plan that the mental health professional or mental health practitioner has developed. The MHBA takes issues that arise in a practice session to the mental health professional or mental health practitioner for resolution.
  • MHBA activities include:

  • • Providing cues or prompts in one-on-one, peer-to-peer or parent-child skill building interactions so that the child progressively recognizes and responds to the cues independently
  • • Performing as a practice partner or role-play partner
  • • Reinforcing the child’s accomplishments
  • • Generalizing skill-building activities in the child’s multiple natural settings
  • • Assigning activities for the child to practice
  • • Intervening as necessary to redirect the child’s target behavior
  • • Intervening to prevent behavior that puts the child or other persons at risk from escalating
  • MHBA Responsibilities

  • • Implement services and treatment strategies in the IEP or IFSP, individual treatment plan and individual behavior plan
  • • Document activities and services provided, including the child’s responses to the treatment strategies, the number of times an activity is practiced and the number of successes and the reasons why the session was unsuccessful
  • • Demonstrate family friendly behaviors that support healthy collaboration among child, child’s family and providers as services are planned and implemented
  • • Communicate effectively with the child, child’s family, mental health practitioner and mental health professional
  • • Complete all required pre-service training and continuing education requirements
  • 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:

  • • Ongoing on-site observation by a mental health professional or mental health practitioner for at least one total hour every forty hours of service provided to a child
  • • Immediate accessibility to the MHP or mental health practitioner during service provision
  • 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

    Service Plan development covers two separately-billable activities:

  • • Individual treatment plan (ITP) development or treatment plan review
  • • Functional assessment administration and outcomes reporting
  • Time and activities that may be billed under this benefit include the following:
  • • Formulating the individual treatment plan or treatment plan review
  • • Contacting and arranging with parents or guardians to develop, review and sign the ITP or ITP review if they are unable to participate at the same time as the treatment team
  • • Meeting with family or client and caregivers to review and address what is to be accomplished through CTSS services
  • • Making arrangements with external entities to make necessary resources available for implementing the ITP
  • • Administering and reporting required standardized measure to Children’s Mental Health Outcome Measures Reporting System
  • 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.

    Record Keeping and Documentation

    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:

  • • The person delivering the service must date and sign (include full signature and title) the notes. The mental health professional who provides clinical supervision must review, approve and sign-off on services provided by a mental health practitioner or MHBA at least every 30 days
  • • Identify changes in treatment strategies
  • • Revise the ITP or IBP communicating treatment instructions and methodologies as appropriate to ensure that treatment is implemented correctly
  • • Demonstrate family friendly behaviors that support healthy collaboration among child, child's family and providers as treatment is planned and implemented
  • • Ensure that mental health behavioral aides are able to effectively communicate with the child, child's family and the provider
  • • Record the results of any evaluation and corrective actions taken to modify the work of mental health behavioral aides
  • Noncovered Services

    Review the information in Basics for All IEP Services subsection of the Covered and Noncovered Services section of this manual.

    Billing

    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.

    Choices for Billing Diagnostic Assessments and Psychological Testing

  • 1. The school chooses option 1, submitting expenditures for only IEP evaluations (performed by a school psychologist)
  • 2. MHP employed by the district conducts DA or psychological testing, submitting the expenditures as part of the IEP evaluation
  • 3. The district contracts with community provider(s), pays the provider’s invoice and submits the expenditure to MHCP as part of the IEP evaluation
  • 4. The district contracts with the community provider. The community provider bills MHCP and any commercial payers. The district will not include the DA or psychological testing as part of the IEP evaluation
  • Refer to the IEP Billing and Authorization Requirements section of this manual for billing requirements.

    Definitions and Acronyms

    IEP Mental Health CTSS Definitions and Acronyms
    IEP Definitions and Acronyms

    Legal References

    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)

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    © 2017 Minnesota Department of Human Services Updated: 7/13/17 2:55 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 7/13/17 2:55 PM