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Adult Crisis Response Services

Revised: 08-15-2014

  • Eligible Providers—Adult Crisis
  • Eligible Recipients
  • Covered Services
  • Crisis Assessment
  • Crisis Intervention
  • Crisis Stabilization
  • Crisis Stabilization Provided in Residential Settings
  • Community Intervention
  • Non-covered Services
  • Criteria for Concurrent Partial Hospitalization or Adult Day Treatment and Residential Crisis Stabilization Services
  • Billing for Adult Crisis Services
  • Definitions
  • Legal References

  • Adult crisis response services are community based services provided by a county, tribe or contracted crisis team to adults age 18 or older.

    Eligible Providers—Adult Crisis

    A crisis response provider must be a county or tribe, or have a contract with a county or tribe.

    A mobile crisis intervention team must consist of:

  • • Two or more mental health professionals or
  • • At least one mental health professional and one mental health practitioner
  • • Certified peer specialists may provide certified peer specialist services during all phases of crisis response
  • Mental health practitioners, certified peer specialists and rehab workers must:

  • • Have completed at least 30 hours of crisis intervention and stabilization training during the past two years
  • • Be under clinical supervision by an MHCP-enrolled mental health professional who:
  • • Is employed by or under contract with the crisis response provider
  • • Accepts full responsibility for the services provided
  • • Consult with the clinical supervisor, in person or by phone, during the first three hours the practitioner provides on-site services
  • The clinical supervisor must:
  • • Be immediately available to staff by phone or in person
  • • Document consultations
  • • Review, approve, and sign the crisis assessment and treatment plan performed by mental health practitioners within one day of the crisis visit
  • • Document on-site observations in the recipient’s record
  • Crisis response providers must be experienced in, and have knowledge of:

  • • Mental health assessment
  • • Treatment engagement strategies
  • • How to work with families and others in the recipient’s support system
  • • Crisis intervention techniques
  • • Emergency clinical decision-making abilities
  • • Local services and resources
  • MHCP strongly encourages MHCP-enrolled crisis services providers to contract with each health plan in their service area. Use the MHCP Health Plan Contacts chart to contact the appropriate managed care organization.

    Contact Tables for:

  • Metro Area Residents (DHS-4485)
  • Greater Minnesota Residents (DHS-4484)
  • Eligible Recipients

    To be eligible for MHCP adult crisis response services, a recipient must be:

  • • Age 18 years or older
  • • Experiencing a mental health crisis or emergency
  • • Includes those recipients with a co-occurring substance abuse and mental health disorders who do not need the level of a detoxification facility.
  • Covered Services

  • Crisis Assessment
  • Crisis Intervention
  • Crisis Stabilization
  • Community Intervention
  • • Certified Peer Specialists may provide Certified Peer Specialist services during all phases of the crisis response
  • Crisis Assessment

    A crisis assessment is an immediate, face-to-face evaluation by a physician, mental health professional or crisis-trained mental health practitioner, to:

  • • Identify any immediate need for emergency services
  • • Determine that the recipient’s behavior is a serious deviation from his/her baseline level of functioning and caused by either a mental health crisis or emergency
  • • Provide immediate intervention to relieve the recipient’s distress
  • • Evaluate, in a culturally appropriate way and as time permits, the recipient’s current:
  • • Life situation
  • • Sources of stress
  • • Symptoms
  • • Risk behaviors
  • • Mental health problems
  • • Strengths and vulnerabilities
  • • Cultural considerations
  • • Support network
  • • Level of Functioning
  • • Whether the person will accept voluntary treatment
  • • Whether the person has an advance directive
  • • History and information obtained from family members
  • Conduct the crisis assessment in one of the following locations:

  • • The recipient’s home
  • • The home of a family member
  • • Another community location
  • Determine the need for crisis intervention services, or referrals to other resources, based on the assessment.

    Crisis Intervention

    Mobile crisis interventions are face-to-face, short-term, intensive mental health services provided during a mental health crisis or emergency. These services help the recipient to:

  • • Cope with immediate stressors and lessen his/her suffering
  • • Identify and use available resources and recipient’s strengths
  • • Avoid unnecessary hospitalization and loss of independent living
  • • Develop action plans
  • • Begin to return to his/her baseline level of functioning
  • Mobile crisis intervention services must be:

  • • Available 24 hours per day, seven days per week, 365 days per year
  • • Provided by a mobile team in a community setting
  • • Provided promptly
  • Mobile crisis response providers can request a waiver of the 24 hour requirement from DHS. To receive a waiver, providers must show that the services cannot be provided 24 hours per day due to one of the following:

  • • Inability to hire qualified staff
  • • Sparse population and wide geographic area to be served
  • Crisis Intervention Treatment Plan
    With the recipient, develop, document and implement an initial crisis intervention treatment plan within 24 hours after the initial face-to-face intervention to reduce or eliminate the crisis. The treatment plan must be culturally and linquistically appropriate for the recipient.

  • • List the recipient’s needs and problems identified in the crisis assessment
  • • Identify:
  • • Frequency and type of services to be provided
  • • Measurable short-term goals
  • • Specify objectives directed toward the achievement of each goal
  • • Note cultural considerations
  • • Recommend needed services, including crisis stabilization
  • • Refer to appropriate local resources, such as:
  • • County social services agency
  • • Mental health services
  • • Local law enforcement
  • • Write clear progress notes of the outcome of goals
  • • Identify frequency and type of services to be provided
  • • Coordinate the planning of other services with the recipient’s case manager, if they have one
  • Update the crisis intervention treatment plan as needed to reflect changes in goals and services.

    If the recipient shows positive change in a baseline of functioning or a decrease in personal distress:

  • • Make (and document) a referral to less intensive mental health services
  • • Document short-term goals that have been met and when no further crisis intervention services are needed
  • • If the recipient is unable to follow-up with a referral, the crisis response provider must link the recipient to the service and follow-up to ensure that the recipient is receiving the service.
  • A mental health professional and the recipient must approve and sign the treatment plan. If the recipient refuses to approve and sign the plan, note the refusal and the reason(s) for the refusal in the treatment plan. Give a copy of the treatment plan to the recipient.

    If services continue 24 hours after the beginning of the face-to-face intervention:

  • • A mental health professional must contact the recipient face-to-face, on the second day, to provide services and update the crisis treatment plan
  • • The mental health professional is not required to be the same professional who was supervising the service when the face-to-face crisis intervention began
  • Crisis Stabilization

    Crisis stabilization services are mental health services, provided after crisis intervention, to help the recipient return his/her functioning to the level it was before the crisis.

  • • Provide stabilization services:
  • • In the community
  • • Based on the crisis assessment and intervention treatment plan
  • • Consider the need for further assessment and referrals
  • • Update the crisis stabilization treatment plan
  • • Provide supportive counseling
  • • Conduct skills training
  • • Collaborate with other service providers in the community
  • • Provide education to the recipient’s family and significant others regarding mental illness and how to support the recipient
  • Crisis Stabilization Treatment Plan
    With the recipient, develop a crisis stabilization treatment plan within 24 hours of beginning services. The crisis stabilization treatment plan, at a minimum, must include:

  • • Problems identified in the assessment
  • • Measurable short-term goals and tasks to be achieved, including time frames for achievement
  • • Specific objectives directed toward achieving each goal
  • • Clear progress notes about outcomes of goals
  • • List of recipient’s strengths and resources
  • • Documentation of participants involved
  • • A crisis response action plan, if another crisis should occur
  • • Frequency and type of services initiated, including a list of providers, as applicable
  • A mental health professional and the recipient must approve and sign the treatment plan. If the recipient refuses to approve and sign the plan, note the refusal and the reason(s) for the refusal in the treatment plan. Give a copy of the plan to the recipient.

    Crisis Stabilization Provided in Residential Settings

  • When Crisis Stabilization services are provided in any residential setting, the following requirements apply:
  • • All staff must have immediate access to a qualified mental health professional or practitioner, 24-hours per day. The access can be direct or by telephone
  • • A qualified mental health professional or practitioner must provide face-to-face contact with the recipient every day
  • When Crisis Stabilization services are provided in residential settings that serve four or fewer adults, the following additional requirements apply:
  • • The setting must be licensed as an adult foster care home
  • • If more than two individuals are receiving crisis response services, one of the following providers must be on site at least 8 hours per day:
  • • Mental health professional
  • • Crisis-trained mental health practitioner
  • • Crisis-trained rehabilitation worker
  • • Crisis-trained certified peer specialist
  • When Crisis Stabilization services are provided in residential settings that serve more than four adults, the following additional requirements apply:

  • • The setting must be licensed under Rule 36 with a Crisis Stabilization variance
  • • One of the following providers must be present 24 hours per day:
  • • Mental health professional
  • • Crisis-trained mental health practitioner
  • • Crisis-trained rehabilitation worker
  • • During the first 48 hours a recipient receives Crisis Stabilization services, at least two staff must be present 24 hours per day. Only one staff is required to be trained in providing crisis services
  • Eligibility for Residential Crisis Stabilization Services
    In addition to the requirements listed under Eligible Recipients, recipients must:

  • • Need residential crisis stabilization services to avoid hospitalization or loss of independent living
  • • Be referred by a mental health crisis team, an Emergency Department physician or a mental health professional
  • Authorization Requirements for Residential Crisis Stabilization
    Authorization is needed to exceed the maximum threshold of 10 days in a calendar month. To request authorization, submit an MHCP Authorization Form (DHS-4695) with the following documentation:

  • • Crisis Assessment, completed before intake by any of the following:
  • • Crisis team
  • • Mental health professional
  • • Emergency department physician
  • • Progress notes from the time of intake
  • • Crisis Stabilization plan
  • • Discharge plan or plans for transitioning to the community, including referrals to other service providers (services are coordinated after the recipient leaves the facility)
  • • Identify symptoms that have not returned to the recipient’s baseline level
  • • Other options considered, including hospitalization and community crisis stabilization
  • • Written explanation of why the recipient needs more time and the anticipated outcome
  • Authorization is not required for crisis assessment, stabilization and intervention

    Community Intervention

    Community intervention may be provided as a crisis service when needed. When provided in the context of crisis response services, community intervention may be used to educate the recipient’s family and significant others on mental illness and ways to support the recipient.

    Non-covered Services

    The following services are not covered as crisis response services:

  • • Recipient transporting services
  • • Crisis response services performed by volunteers
  • • Provider performance of household tasks, chores, or related activities, such as:
  • • Laundering clothes
  • • Moving the recipient’s household
  • • Housekeeping
  • • Grocery shopping
  • • Time spent “on call” and not delivering services to recipients
  • • Activities primarily social or recreational in nature, rather than rehabilitative
  • • Job-specific skills services, such as on-the-job training
  • • Case management
  • • Outreach services to potential recipients
  • • Crisis response services provided by a:
  • • Hospital
  • • Board and lodging facility
  • • Residential facility (except for qualified Residential Crisis Stabilization Settings)
  • • Room and board
  • Criteria for Concurrent Partial Hospitalization or Adult Day Treatment and Residential Crisis Stabilization Services

    An authorization is required to provide partial hospitalization or adult day treatment concurrently with residential crisis stabilization services. The partial hospitalization or day treatment provider must submit a request for authorization to the medical review agent, along with a letter of support from the residential crisis stabilization provider, if the recipient meets at least one of the following:

  • • Was already attending partial hospitalization services or adult day treatment and continuation of these services adds appropriate continuity to their life
  • • Can benefit from more intensive therapeutic intervention, that the crisis stabilization facility cannot provide
  • • Needs specific therapeutic intervention the crisis stabilization program cannot provide (treatment for eating disorders, obsessive/compulsive disorder, etc.)
  • • Is transitioning to partial hospitalization services or day treatment following the stay at the crisis stabilization facility
  • Billing for Adult Crisis Services

  • • Bill for direct, face to face service(s) provided to an eligible recipient by a qualified staff person
  • • Use MN–ITS 837P
  • • Enter the actual place of service code (POS)
  • • Enter the individual treating provider NPI number
  • • When an off-site team member (professional) works with an on-site team member, the professional may bill for time spent working directly with the on-site member
  • • Two team members who are providing services on-site may bill for time spent providing service
  • Adult Crisis Service Billing

    Code

    Modifier

    Service Description

    Unit

    Additional Requirements

    S9484

     

    Adult crisis assessment, intervention and stabilization – individual by a mental health professional

    60 minutes

    Except for Community Intervention (see below) there are no thresholds for crisis response services provided in the community. Authorization is not required for crisis assessment, stabilization and intervention.

    Rehabilitation workers can provide adult crisis stabilization services only.

    HN

    Adult crisis assessment, intervention and stabilization – individual practitioner

    S9484

    HM

    Adult crisis stabilization – individual by mental health rehabilitation worker

    HQ

    Adult crisis stabilization - group

    H0018

     

    Adult crisis stabilization, residential

    1 day

    Authorization is required for more than 10 days in a calendar month.

    90882

    HK

    Community Intervention

    1 session

    Community intervention may be billed for each team member when one team member works directly with a family member or significant other while the other team member works face-to-face with the recipient.

    Follow ARMHS billing instructions -ARMHS authorization thresholds apply.

    The HK modifier is needed to identify community intervention services as a part of crisis response.

    90882

    HK
    HM

    Community Intervention by a mental health rehabilitation worker


    Definitions

    Mental health crisis: A behavioral, emotional, or psychiatric situation that would likely result in significantly reduced levels of functioning in primary activities of daily living or in the placement of the recipient in a more restrictive setting (such as inpatient hospitalization).

    Mental health emergency: A behavioral, emotional, or psychiatric situation which causes an immediate need for mental health services.

    Legal References

    MS 256B.0624 Adult Crisis Response Services
    MS 256B.0623
    , subd. 7 Rehab Option Background Study requirement
    MS 148
    Psychotherapist Background Study requirement

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