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Adult Day Treatment

Revised: 07-08-2014


Adult day treatment is an intensive psychotherapeutic treatment. The goal of day treatment is to reduce or relieve the effects of mental illness and provide training to enable the recipient to live in the community.


Eligible Adult Day Treatment Providers
The following agencies may apply to become day treatment providers:

• Licensed outpatient hospitals with JCAHO accreditation
• MHCP-enrolled community mental health centers
• Entities under contract with a county to operate a day treatment program

Individual members of the adult day treatment multidisciplinary team must meet, at a minimum, the standards for a mental health practitioner. Psychotherapy components of day treatment must be provided by a mental health professional or a mental health practitioner qualified as a clinical trainee.

Follow group psychotherapy guidelines for staffing and group size requirements.

If providing children’s day treatment to recipients ages 18 - 20 years, providers must also be CTSS-certified.

Clinical Supervision
Adult day treatment providers are required to follow Clinical Supervision of Outpatient Mental Health Services (Rule 47) guidelines.


Eligible Recipients
Eligible recipients of adult day treatment must:

• Be eligible for MHCP
• Be age 18 years or older (recipients age 18 - 20 years may receive adult day treatment, CTSS, or both, depending on medical necessity)
• Meet all criteria for admission or continuing stay, below

Recipients enrolled in a managed care organization (MCO) must receive day treatment services through the MCO, which may have different coverage and authorization requirements.

Admission Criteria
For admission, a recipient must:

• Have a primary diagnosis of mental illness as determined by a Diagnostic Assessment, excluding dementia and other organic conditions
• Have three or more areas of significant impairment in functioning as determined by a Functional Assessment
• Have a completed LOCUS assessment with a Level 3 indication
• Be experiencing symptoms impairing thought, mood, behavior or perception that interfere with the ability to function with a lesser level of service
• Have the cognitive capacity to engage in and benefit from this level of treatment
• Reasonably be expected to benefit in improved functioning at work, school, or social relationships
• Need a highly structured, focused treatment approach to accomplish improvement and to avoid relapse requiring higher level of treatment

Day treatment may also be appropriate for:

• Recipients with a brain injury (BI) diagnosis that co-exists with the primary mental illness diagnosis
• Court ordered treatment or for a recipient who is a potential danger to self, if the program provides adequate structure and sufficient support systems exist in the community
• Recipients residing in inpatient or residential facilities (nursing facilities, IMDs, hospitals, RTC), when an active discharge plan indicates a move to an independent living arrangement within 180 days. A mental health professional must deem the day treatment services medically necessary and the facility plan of care must include day treatment

Continuing Stay Criteria
For a recipient to continue treatment, the following criteria must be met:

• The recipient’s condition continues to meet admission criteria as evidenced by active psychiatric symptoms and continued functional impairment
• The treatment plan contains specific goals and documented measurable progress toward goals
• An active discharge plan is in place
• Attempts to coordinate care and transition to other services are documented, as clinically indicated

Include interventions provided and the recipient’s response in the recipient’s daily record.

Discharge Criteria
Discharge a recipient who meets any of the following:

• Treatment plan goals and objectives have been met
• No longer meets continuing stay criteria
• Mental health disorder(s) have decreased and lesser level of service is appropriate
• Is voluntarily involved in treatment and no longer agrees to attend day treatment
• Exhibits severe exacerbation of symptoms and/or disruptive or dangerous behaviors requiring more intensive level of service. Do not close chart if individual is expected to return to day treatment
• Does not participate despite multiple attempts to engage the person and address nonparticipation issues
• Does not make progress toward treatment goals and no reasonable expectation that progress will be made
• No longer meets the criteria for a LOCUS level 3
• Does not have or ceases to have the cognitive capacity to benefit from day treatment services. Refer recipient to the county human service or private agency for other services, such as:
• Day habilitation programs
• Adult day care
• Waiver program services

Covered Day Treatment Services
Adult day treatment consists of:

• At least one hour of group psychotherapy (maximum of two hours)
• Group time focused on rehabilitative interventions, or other intensive therapeutic services, provided by a multidisciplinary staff
• A group of at least 3, but not more than 12, recipients

The services must:

• Stabilize the recipient's mental health status
• Develop and improve the recipient’s independent living and socialization skills
• Be included in the recipient's individual treatment plan (ITP). The ITP must:
• Be completed before the first session
• Include attainable, measurable goals as they relate to day treatment services
• Be reviewed by the provider and updated with recipient progress at least every 30 days, until discharge
• Include an attainable discharge plan for the recipient

Non-covered Services
The following services or activities may not be billed as day treatment:

• Services provided to recipients residing in an inpatient or residential facility (except when following the discharge plan guidelines, listed under Admission Criteria)
• Primarily recreation-oriented, non-medically supervised services or activities, including, but not limited to:
• sports activities
• exercise groups
• craft hours
• leisure time
• social hours
• meal or snack time or preparation
• trips to community activities
• tours
• Social or educational services that do not have or cannot reasonably be expected to have therapeutic outcomes related to the recipient’s mental health condition
• Consultations with other providers or service agency staff about the care or progress of a recipient
• Prevention or education programs provided to the community
• Day treatment for recipients with a primary diagnosis of alcohol or other drug abuse
• Day treatment provided in the recipient’s home
• Psychotherapy for more than two hours daily
• Participation in meal preparation and eating that is not part of a clinical treatment plan to address a recipient’s eating disorder
• Services not included in the recipient’s treatment plan as medically necessary and appropriate
• Less intensive services, such as a “club-house” or social program not covered by MHCP

Authorization
Refer to Authorization for general authorization policy and procedures. For Adult Day Treatment, authorization is required to:

• Exceed 115 hours of day treatment per calendar year
• Provide adult day treatment services concurrent with other services

To request authorization, submit the following:

MHCP Authorization Form (DHS-4695) (except when using MN–ITS)
Adult Mental Health Rehabilitative Services Authorization Form (DHS-4159A)
• Most current Diagnostic Assessment
• Current Functional Assessment
• Current Individual Treatment Plan
• Discharge Plan, if active
• Current interpretive summary
• LOCUS

Special Consideration for Concurrent Residential Crisis Stabilization
The day treatment provider must submit a request for authorization, 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 adult day treatment and continuation of these services adds appropriate continuity to their life
• Needs more intensive therapeutic intervention than the crisis stabilization facility can provide
• Needs specific therapeutic intervention that the crisis stabilization program cannot provide (treatment for eating disorders, obsessive/compulsive disorder, etc.)
• Is transitioning to day treatment following the stay at the crisis stabilization facility

Authorization for Targeted Clinical Services Programs
Follow all threshold and authorization requirements for adult day treatment. For Targeted Clinical Services, the following additional documentation requirements also apply:

• Complete a Functional Assessment and LOCUS every six months
• The recipient’s treatment plan, including:
• Treatment guidance for a six month time period
• Monthly reviews and updates on goals and objectives
• Progress notes for the previous two weeks. For recipients who progress more slowly, a quarterly report may be used to emphasize progress
• Optional, additional assessments of:
• Cognitive functioning
• Risk of re-offense

Billing
• Bill day treatment services online using MN–ITS 837P
• Do not use a modifier
• Do not provide or bill for Adult Day Treatment for children under age 18 years

Adult Day Treatment
Code Description Units Limitations
H2012 Behavioral Health Day Treatment 1 hour Maximum 15 hours per week - may not obtain authorization for more day treatment hours in a week

115 hours per calendar year without authorization

Legal References
Minnesota Rules 9505.0370 to 9505.0372 MA Outpatient Mental Health Services
Minnesota Rules 9520.0750 to 9520.0870
Mental health center/clinic standards (Rule 29)
Minnesota Rules 9520.0800
Minimum quality assurance standards (Rule 29)
MS 245.62
Establishing a mental health center


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