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Department of Human Services Department of Human Services  
 
Mental Health Services

Revised: 04-03-2014


Overview
Minnesota’s publicly provided mental health system, as reflected in the Minnesota Comprehensive Mental Health Acts, is DHS-supervised and county-administered. Counties act as the local mental health authority. Review Mental Health Provider Requirements for information about criteria to be an eligible Minnesota Health Care Program (MHCP) mental health provider.

Components of Service Delivery
Mental health service delivery is composed of six key components:

• Diagnostic assessment (functional assessment tools – Children’s Mental Health)
Functional Assessment (Adult)
Level of Care Assessment (LOCUS – Adult Mental Health)
• Individual treatment plan (ITP)
• Service delivery
• Reassessment

DHS image

Eligible Providers
Mental health providers include agencies and individuals (professionals and practitioners). Each mental health agency must have at least one mental health professional on staff. Providers may be eligible to enroll as MHCP providers (mental health professionals) or may be eligible to provide services but not eligible to enroll as MHCP providers (mental health practitioners, CTSS mental health behavioral aide).

When qualified state staff provides adult mental health services, they are considered part of the certified local provider entity and their services may be billed according to typical billing practices as appropriate to the specific service.

Enrollable Mental Health Agencies
• Adult Day Treatment
• Billing Entity for Mental Health
• County-contracted Mental Health Rehabilitation Service
• Community Mental Health Center (CMHC)
• County Human Service Agency
• Indian Health Service (IHS)/638 facilities
• Outpatient hospital
• Physician-directed clinic
• School district

Enrollable Mental Health Professionals

Non-Enrollable Mental Health Providers

General Clinical Supervision Requirements
Clinical supervision is the process of control and direction of a recipient’s mental health services by which a MHCP enrolled mental health professional accepts full professional responsibility for the supervisee’s actions and decisions, instructs the supervisee in the supervisee’s work, and oversees or directs the work of the supervisee.

MHCP has more than one mental health clinical supervision standard:

• Refer to Clinical Supervision of Outpatient Mental Health Services for requirements on supervision of Diagnostic Assessment, Psychotherapy and Explanation of Findings
• Refer to the Specialty Specific Mental Health Supervision Requirements chart and specific covered services sections for other supervision requirements

Medicare Enrollment Denials
When enrollment as a Medicare provider is denied, the following MHCP providers must submit the denial letter from Medicare to MHCP Provider Enrollment:

• LICSW
• LP
• NP or CNS with mental health specialty

Submit the Mental Health Professional Applicant Assurance Statement – Medicare Enrollment Denial (DHS-3864) every 18 months after the date of initial Medicare denial. Inform MHCP Provider Enrollment immediately when Medicare approves enrollment.

Right to Appeal Denial of Certification or County Contract
Providers required to be certified by or contracted with a county, as part of the criteria to become an authorized provider of mental health services, may appeal a county refusal to grant the necessary contract or certification. A recipient may initiate an appeal on behalf of a provider denied certification. A request for a review of the county decision may be submitted to the Adult or Children’s Mental Health Division:

Fax (adult):

(651) 431-7418 (Attn: Mental Health Appeal Review)

Fax (children):

(651) 431-2321 (Attn: Mental Health Appeal Review)

Mail:

DHS Mental Health Division – Appeal Review
PO Box 64981
444 Lafayette Rd
St Paul MN 55164-0981


Eligible Recipients
Recipients eligible to receive mental health services must be eligible for MHCP.

A resident of an Institution for Mental Disease (IMD) is eligible to receive MA services only if the recipient is receiving inpatient psychiatric care in a JCAHO-accredited psychiatric facility and meets one of the following criteria:

• Is under age 21 years
• Is age 21 years but less than 22 years and has been receiving inpatient psychiatric care in the IMD continuously since the resident’s 21st birthday
• Is at least age 65 years

Recipients age 21 years and over but under age 65 years and residing in an IMD must receive their mental health services through the IMD. A recipient discharged from the IMD may become eligible for mental health services if eligibility criteria are met. The recipient, if discharged within 180 days is eligible to receive case management services through Relocation Service Coordination (RSC). Contact the managed care organization if the recipient is receiving services through the managed care organization.

Most mental health services have recipient eligibility requirements that require the recipient to meet the criteria in one or more of the following definitions:

• Child with emotional disturbance: A child with an organic disorder of the brain, or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that:
• Is listed in the clinical manual of the ICD-9-CM, code range 290.0 to 302.9 or 306.0 to 316.0
• Seriously limits a child’s capacity to function in primary aspects of daily living such as personal relations, living arrangements, work, school, and recreation

Emotional disturbance is a general term and intended to reflect all categories of disorder described in the ICD code ranges listed above, as usually first evident in childhood or adolescence.
• Mental Illness: An organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that is listed in the ICD-9 CM, code range 290.0 to 302.9 or 306.0 to 316.0.
• Serious and persistent mental illness (SPMI): A condition with a diagnosis of mental illness that meets at least one of the following:
• The recipient had two or more episodes of inpatient care for mental illness within the past 24 months
• The recipient had continuous psychiatric hospitalization or residential treatment exceeding six months’ duration within the past 12 months
• The recipient has been treated by a crisis team two or more times within the past 24 months
• The recipient has a diagnosis of schizophrenia, bipolar disorder, major depression or borderline personality disorder, evidences a significant impairment in functioning, and has a written opinion from a mental health professional stating he/she is likely to have future episodes requiring inpatient or residential treatment unless community support program services are provided
• The recipient has, in the last three years, been committed by a court as a mentally ill person under Minnesota statutes, or the adult’s commitment as a mentally ill person has been stayed or continued
• The recipient was eligible under one of the above criteria, but the specified time period has expired
• The recipient was eligible as a child with severe emotional disturbance, and the recipient has a written opinion from a mental health professional, in the last three years, stating that he/she is reasonably likely to have future episodes requiring inpatient or residential treatment of a frequency described in the above criteria, unless ongoing case management or community support services are provided
• Severe emotional disturbance (SED): When a child with emotional disturbance:
• Has been admitted to inpatient/residential treatment within the last three years or is at risk of being admitted
• Is a Minnesota resident and receiving inpatient or residential treatment for an emotional disturbance through the interstate compact
• Has been determined by a mental health professional to meet one of the following criteria:
• Have psychosis or clinical depression
• Be at risk of harming self or others as a result of emotional disturbance
• Has psychopathological symptoms as a result of being a victim of physical/sexual abuse or psychic trauma within the past year
• Has a significantly impaired home, school or community functioning lasting at least one year or presents a risk of lasting at least one year, as a result of emotional disturbance, as determined by a mental health professional.

Refer to Relocation Services Coordination Targeted Case Management for more information.

Recipients not eligible for mental health services are those eligible for one of the following programs:

AC Alternative Care Program
FP MFPP
QM Qualified Medicare Beneficiary

Covered Services
Some MH services may be delivered by Telemedicine. Review also the MHCP MH Code and Rates Chart (PDF).

The following are covered mental health services (refer to the linked sections for additional service-specific information):

• Crisis Services
Metro Area Residents (DHS-4485)
Greater Minnesota Residents (DHS-4484)
• Rehabilitative Mental Health Services
• Physician Mental Health Services

Non-covered Services
The following are not covered MHCP mental health services:

• Mental health services provided by a non-psychiatrist, except psychological testing, to a recipient who is inpatient and has a mental illness diagnosis (these services are included in the hospital’s payment)
• Mileage (provider travel time is not the same as mileage)
• Transporting a recipient, except for case managers
• Telephone calls, unless otherwise specified in service coverage sections (example: adult MH-TCM)
• Written communication between provider and recipient
• Reporting, charting and record keeping (these activities are considered part of providing services)
• Community planning or consultation, program consultation/monitoring/evaluation, public information, training and education activities, resource development, and training activities
• Fund-raising
• Court-ordered services for legal purposes
• Mental health services not related to the recipient’s diagnosis or treatment for mental illness
• Services dealing with external, social, or environmental factors not directly addressing the recipient’s physical or mental health
• Staff training
• Mental health case management for recipients receiving similar services through the Veterans Administration (VA)
• Duplicate services
• Mental health services provided by a school or local education agency, unless the school or agency is an MHCP-enrolled provider and the services are medically necessary and prescribed in the child’s ITP/IEP
• Mental health services provided by an entity whose purpose is not health service related (for example, services provided by the Division of Vocational Rehabilitation or Jobs and Training);
• Legal services, including legal advocacy, for the recipient
• Information and referral services included in the county’s community social service plan
• Outreach services through the community support services program
• Assistance in locating respite care, special needs day care, and assistance in obtaining financial resources, except when these services are provided as part of case management
• Client outreach
• Recreational services, including sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack times, trips to community activities, etc.

Legal References
MS 147 Board of Medical Practice (for psychiatrist licensure requirements)
MS 148
Public Health Occupations
MS 148.171 – 148.285
Minnesota Nurse Practice Act
MS 148.88 – 148.98
Minnesota Psychology Practice Act
MS 148.907
Licensed Psychologist
MS 148.925
Supervision
MS 148B.29 to 148B.39
Marriage and family therapy
MS 148D.055
Board of Social Work, License Requirements
MS 245
Department of Human Services
MS 245.461 – 245.486
Adult Mental Health Act
MS 245
.487 – 245.4887
Children’s Mental Health Act
MS 245.4889 – 245.490
Children’s Mental Health Grants
MS 245.491 – 245.90
Children’s Mental Health Integrated Fund
MS 256B
Medical Assistance for Needy Persons (includes covered mental health services)
MS 256L.03
MinnesotaCare, Covered Health Services
Minnesota Rules 9505
Health Care Programs
Minnesota Rules 9505.0322
Mental Health Case Management Services
Minnesota Rules 9505.0370
9505.0372
Outpatient Mental Health Services (Rule 47)
Minnesota Rules 9
505.0540
Criteria for Readmissions
Minnesota Rules 9505.2175 – 9505.2180
Health Service Records, Financial Records, Access to Records
Minnesota Rules 9505.5000 – 9505.5105
Conditions for MA and GAMC Payment
Minnesota Rules 9520
Mental Health Services
Minnesota
Rules 9520.0750 – 9520.0870
Mental Health Center and Mental Health Clinic Standards (Rule 29)
Minnesota Rules
9520.0900 – 9520.0926
Case Management for Children with SED (Rule 79)
Minnesota Rules 9535.4068
Standards for Family Community Support Services for Children with SED and their Families (Rule 15)
42 CFR 435.1008
1009 (IMD) FFP in expenditures for medical assistance for individuals who have declared United States citizenship or nationality…; Institutionalized individuals
42 CFR 440.60
(a) Medical or other remedial care provided by licensed practitioners
42 CFR 4
40.160
Inpatient psychiatric services for individuals under age 21
42 CFR 440.170
(e) Any other medical care or remedial care recognized under State law and specified by the Secretary, Emergency hospital services
42 CFR 440.230
Sufficiency of amount, duration, and scope
Tit
le XIX, Section 1915(g)
of the Social Security Act (MH-TCM)

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