Adult rehabilitative mental health services (ARMHS) serve the following purposes:
• Enable a recipient to develop and enhance psychiatric stability, social competencies, personal and emotional adjustment, and independent living and community skills, when these abilities are impaired by the symptoms of mental illness
• Enable a recipient to retain stability and functioning if the recipient is at risk of losing significant functionality or being admitted to a more restrictive service setting without these services
• Instruct, assist, and support a recipient in areas such as medication education and monitoring; and basic social and living skills in mental illness symptom management, household management, employment-related, or transitioning to community living
Each ARMHS provider entity must be certified to provide ARMHS. Certification ensures that the provider is capable of providing directly, or contracting for, the full array of ARMHS.
Non-county entities must receive additional certification from each county in which they provide services. The additional certification must be based on the entity’s knowledge of the county’s local health and human services system, and the ability of the entity to coordinate its services with other services available in that county.
County-operated entities must receive additional certification from any other counties in which they will provide services.
ARMHS entities must be recertified every three years.
The following individual mental health professional providers are eligible to provide ARMHS:
• Clinical nurse specialist in mental health
• Licensed independent clinical social worker (LICSW)
• Licensed marriage and family therapist (LMFT)
• Licensed psychologist (LP)
• Licensed professional clinical counselor (LPCC)
• Mental health rehabilitation professional
• Nurse practitioner with psychiatric specialty (NP)
• Mental health practitioner
• Mental health rehabilitation worker
• Certified peer specialist
The following providers are eligible to provide medication education services under ARMHS:
• Registered nurse
• Physician assistant
Eligible recipients for ARMHS must meet all of the following criteria:
• Be age 18 years or older
• Have a primary diagnosis of a serious mental illness as determined by a Diagnostic Assessment
• Have a completed LOCUS assessment that indicates a Level 3 or Level 2
• Have a significant impairment in functioning in three or more areas of the Functional Assessment domains specified in statute
The following seven services are billable as ARMHS:
• Basic living and social skills
• Certified peer specialist services
• Community intervention
• Functional assessment
• Individual treatment plan
• Medication education
• Transition to community living services
ARMHS services may be provided in the following settings:
• A recipient’s home
• The home of a relative or significant other
• A recipient’s job site
• The community, such as any of the following:
• Psychosocial clubhouse
• Drop-in center
• Social setting
• Other place in the community
Do not provide ARMHS, except for services that meet the requirements under Transition to Community Living Services, to a recipient residing in any of the following:
• Regional treatment centers
• Nursing facilities
• Acute-care settings (inpatient hospital)
• Sub-acute settings (Intensive Residential Treatment Services (IRTS) program)
Basic living and social skills are activities that instruct, assist and support a recipient in skill areas essential for everyday, independent living. Examples of skill areas include the following:
• Interpersonal communications
• Community resource utilization and integration
• Crisis assistance
• Relapse prevention
• Budgeting, shopping and healthy lifestyle skills and practices
• Cooking and nutrition
• Medication monitoring
• Mental illness symptom management
• Household management
• Employment-related skills
• Transitioning to community living
Each recipient’s treatment plan should identify specific skills needed, how each is being addressed, the modality (individually, group), and the medical necessity for each goal.
Provide basic living and social skills individually or in a group setting, when appropriate to each participating recipient’s needs and treatment plan. A basic living and social skills group is 2 – 10 people, at least one of whom is an MA recipient. Up to two staff members may bill MHCP for services provided to a group. Each staff person must bill for different recipients.
Provide basic living and social skills directly (face-to-face) to the recipient. Do not bill if the contact is conducted by telephone.
Certified peer specialist services (CPSS) are specific rehabilitative services emphasizing the acquisition, development and enhancement of skills a person with a mental illness needs to move forward in his or her recovery. These services are self-directed and person-centered with a focus on recovery. CPS services are identified in a treatment plan or an individualized Treatment plan (ITP) and are characterized by a partnering approach between the CPS and the person who receives the services (peer). As a member of the team, the CPS uses a non-clinical approach that helps the person discover their strengths and develop their own unique recovery goals. The peer specialist models wellness, personal responsibility, self-advocacy, and hopefulness through appropriate sharing of his or her story.
CPSS include the following:
• Non-clinical, recovery-focused activities encouraging empowerment, self-determination, and decision-making, which are only provided by a CPS.
• Activities that can address and contribute to the ARMHS team insights about feelings associated with stigma, social isolation, personal loss, systemic power dynamics and restoring one’s lifestyle following hospitalization, or other acute care services.
An advanced certified peer specialist (CPS) level II can develop the functional assessment (FA) and the ITP. A co-signature is not needed on progress notes.
Refer to the Certified Peer Specialist Services section of this manual for more information.
Community intervention is a service of strategies provided on behalf of a recipient to do the following:
• Alleviate or reduce a recipient’s barriers to community integration or independent living
• Minimize the risk of hospitalization or placement in a more restrictive living arrangement
Community intervention may be conducted with an agency, institution, employer, landlord or recipient’s family and may require the involvement of the recipient’s relatives, guardians, friends, employer, landlord, treatment providers, or other significant people, to change situations and allow the recipient to function more independently.
Delivery of community intervention services meets the following:
• Must be directed exclusively to the treatment of the recipient
• Must be provided on an individual basis only (cannot be provided in a group)
• May be conducted in person or by telephone, if the intervention strategy warrants it (document accordingly)
• May be conducted without the recipient present when the intervention strategy warrants it (document why the strategy is more effective without the recipient present)
Do not bill community intervention for the following reasons:
• Routine communication between members of a treatment team, a routine staffing, or a care conference
• Telephone contacts that do not conform to the definition of this service or that are not properly documented
• Clinical supervision or consultation with other professionals
• Treatment plan development
The billable service of an FA includes the functional and LOCUS assessments, and the interpretive summary. A comprehensive FA is a narrative that describes how the person’s mental health symptoms impact their day-to-day functioning in a variety of roles and settings. It is important to look at how factors other than mental health symptoms impact life functioning.
The assessment of functional ability identifies and describes the following:
• The person’s functional strengths and deficits
• The person’s current status within each life domain
• The linkage between the symptoms of mental illness and the identified functional impairment within each life domain (if applicable)
The functional assessment should primarily reflect the person’s current functioning based on interviews and observational data. It is helpful to gather the data from the recipient in his or her home or community settings. To determine a person’s functioning baseline it is important to take into account the person’s history and include input from other people associated with the person. The assessment is nonjudgmental; it describes what is rather than what should be.
Information obtained in the FA helps determine goals, objectives and relevant treatment interventions pertinent to each person’s needs. By incorporating strengths in the assessment, it enriches the possibilities of how a goal can be achieved.
Refer to Functional Assessments in this manual for more information.
Assessment of functional ability informs the LOCUS (level of care utilization system) assessment, which determines the service intensity needs of the individual. Refer to the LOCUS section of this manual for more information.
The interpretive summary is used to synthesize the information obtained from the three-tier assessment process (diagnostic, functional and LOCUS) to prioritize direction for the upcoming individual treatment plan. It is an essential bridge or link from assessment to service planning.
An interpretive summary does the following:
• Identifies what outcomes the person desires relative to his or her life circumstances and preferences
• Describes how the mental health symptoms are affecting the person’s and his or her family’s life
• Summarizes the nature of the functional barriers as they relate to symptoms of the mental illness to establish the priorities for the next treatment plan
• Examines the person’s strengths, abilities and resources
• Examines how the person’s strengths, abilities and resources can be engaged to improve functioning and move forward on identified desirable recovery outcomes
• Establishes the priorities for the initial and subsequent individual treatment plan
• Recommends services and interventions
The mental health clinical supervisor or mental health practitioners under the supervision of the mental health professional clinical supervisor must complete the interpretive summary. The mental health professional and mental health practitioner must sign the interpretive summary.
An individual treatment plan (ITP) is a written plan that documents the treatment strategy, the schedule for accomplishing the goals and objectives, and the responsible party for each treatment component. Complete an individual treatment plan before mental health service delivery begins.
An ITP of any ARMHS services is based on a diagnostic and functional assessment, documents the plan of care and guides treatment interventions. Development of the ITP includes involvement of the client, client’s family, caregivers, or other people, which may include people authorized to consent to mental health services for the client, and includes arrangement of treatment and support activities consistent with the client’s cultural and linguistic needs.
The ITP focuses on the person’s vision of recovery, his or her priority treatment goals and objectives, and the interventions that will help meet those goals and objectives. The plan must be written in a way in which the person and his or her family have a clear understanding of the services being offered and specifically how the services will address their concerns. The person must take part in the process of developing the ITP to make sure the treatment is relevant to their priorities and incorporates their strengths.
When completing the ITP for adults, the following components must be present on the plan:
• Cultural considerations, as related to service plan and delivery
• A list of functional barriers to be addressed in the plan
• Strength and resources that are a benefit in this time of change
• Referrals to be pursued, if any
• Information about service coordination that identifies the following:
• Other service providers
• The service
• Frequency and form of routine contact between ARMHS and other providers
• Recipient’s progress (or lack thereof) must be documented as a written review that evaluates progress toward goals and objectives from the previous plan
• Signature and date line for the recipient or legal guardian and ARMHS provider
Give a copy of the approved plan to the recipient or guardian.
If an individual refuses to sign the plan, document efforts to engage the person in his or her treatment plan and why he or she was not willing to sign the plan.
Additional requirements for the ITP include the following:
• Recovery Vision: reflects the person’s aspirations regarding their life stated in their own words
• Goal (Rehab): A target for change that is achievable within nine months to three years. A goal describes a target for change that will result in achieving a desired outcome. The recommendation is fewer than two rehabilitative goals within a plan.
• Objectives: achievable within six months or less. A small positive forward step describing what the person will be able to do or the result to be realized. The ITP outlines the small steps the person will take. The recommendation is fewer than three objectives that can be targeted sequentially or concurrently to attain the goal. Objectives are measurable and observable with an identified baseline and target measure.
• Interventions: rehabilitation techniques that ARMHS staff will use to help a person reach objectives, which lead to completing goals. Intervention can focus on using community resources or natural support networks and skill development, mastery or generalization associated with a specific role or setting. The intervention must include the following:
• A proposed timeline for completion
• Identified skills or skill set to be learned, mastered or generalized
• Where the intervention will take place
• Description of the type of rehabilitative intervention to be used such as demonstrating, modeling, showing or practicing
• Type of service modality 1:1 or group
• Length of typical session
• Frequency of session
• Timeframes for rehabilitative objectives and interventions
• Service category: basic living and social skills (BLSS), medication education (ME), community intervention (CI), transition to community living (TCL) or certified peer specialist (CPS))
• Develop and approve an ITP within 30 days of the ARMHS intake or start date.
• Update the ITP every six months, at a minimum
A mental health professional or mental health practitioner under the clinical supervision of a mental health professional must complete the following:
• The client must sign and receive a copy of the ITP; if the client is unable to sign the ITP a reason must be listed
• The mental health professional or mental health practitioner under the clinical supervision of a mental health professional
The ITP must be signed by the following:
The medication education service educates a recipient about the following:
• Mental illness and symptoms
• The role and effects of medications in treating symptoms of mental illness
• The side effects of medications
Medical education is coordinated with, but not duplicative of, medication management services. The recipient must be present to bill for the service.
Criteria for medication education are as follows:
• May include activities that instruct recipients, families, or significant others in the correct procedures for maintaining a recipient’s prescription medication regimen
• May be provided individually or in a group setting
• Must be provided only by a physician, pharmacist, registered nurse or physician’s assistant employed by or subcontracted with a certified ARMHS provider. The ARMHS provider bills for medication education.
If medication education is provided in a pharmacy, ensure that the service is provided apart from the dispensing area. Medication education is not intended to replace any aspect of dispensing medications. Information provided to a recipient as part of a prescription is an aspect of dispensing medications; is paid separately, in the dispensing fee; and is not billable as medical education.
Mental health rehabilitation workers cannot develop a FA, LOCUS, interpretive summary, or ITP. The MHRW can implement ITP interventions and develop a progress note co-signed by the MHP clinical supervisor or treatment director.
Transition to community living (TCL) services are developed for the following purposes:
• To establish or re-establish contact between an ARMHS provider and the recipient prior to the recipient’s discharge from a higher level of care mental health service, including any of the following:
• Regional Treatment Center
• Community hospital
• Intensive Residential Treatment program
• Board and care facility
• Skilled nursing home
• ACT program
• To implement the discharge plan developed by the higher level of care mental health service
• To be coordinated with, but not duplicate the discharge planning responsibilities of the higher level of care service
• To be provided within a maximum of 180 days of discharge from the higher level of care service
• TCL services cannot be provided concurrently with other ARMHS services. TCL is available only when the recipient is receiving a higher level of care service. TCL services must be authorized according to Authorization Requirements for TCL Services.
TCL services do not count toward the 300 hours or 72-session limit for Basic Living and Social Skills or Community Intervention service categories.
A progress note describes the rehabilitative service delivered. You must complete a progress note to bill for all services.
Progress notes must include the following:
• Type of service
• Date of service
• Session start and stop times
• Scope of service (nature of interventions or contacts, treatment modalities, phone contacts, etc.) includes these components:
• Goal and objective targeted in the session
• Intervention delivered and methods used
• Recipient’s response or reaction to treatment intervention(s)
• Plan for the next session
• Service modality (group or individual)
• Service location
• Signature and printed name and qualification of the person who provided the service
• Significant observations that may also be documented, include the following:
• Current risk factors the recipient may be experiencing
• Emergency interventions
• Consultations with or referrals to other professionals, family or significant others
• Summary of effectiveness of treatment, prognosis, discharge planning, etc.
• Test results and medications
• Changes in symptoms (physical and mental health)
The following services are not covered ARMHS:
• Recipient transporting services
• Services provided and billed by providers not enrolled to provide ARMHS
• ARMHS performed by volunteers
• Provider performance of household tasks, chores, or related activities, such as laundering clothes, moving the recipient’s household, housekeeping, and grocery shopping for the recipient
• Time spent “on call” and not delivering services to recipients
• Activities that are primarily social or recreational, rather than rehabilitative
• Job-specific skills services such as on-the-job training
• Time included in case management services
• Outreach services to potential recipients
• Room and board services
Request authorization for services exceeding the limits as indicated in the ARMHS Benefits chart (see Billing section below) for Basic Living and Social Skills, Community Intervention, Functional Assessment, Individual Treatment Plan and Medication Education. To request authorization, submit the following:
If ARMHS services are provided concurrently with adult mental health day treatment, the second provider of record must submit the request for authorization. The request must include correspondence from the first provider, which verifies how services will be coordinated and scheduled. This is to assure that the recipient is receiving distinct periods of service, which occur separately from each other service.
The recipient’s record must include supporting documentation (the treatment plan) that describes how concurrent ARMHS services are necessary.
Providers must request authorization for all TCL services before service delivery or within a reasonable amount of time after services begin. To request authorization, submit the following:
• Diagnostic Assessment
• Functional Assessment
• Interpretive Summary
• Proposed discharge plan
• Progress notes for the past six sessions or two weeks, whichever is greater (for IRTS – two weeks)
• The discharge goal, which identifies the functioning that must be restored for the recipient to successfully reenter their community living environment
• The following documentation generated by the ARMHS provider:
• A brief statement, signed by the ARMHS MHP clinical supervisor, indicating their examination of the submitted documentation and eligibility approval for ARMHS
• The proposed ARMHS TCL plan, which meets the following criteria:
• Is coordinated with the assessment and discharge plan generated by the higher level of care provider
• Is limited to a maximum of 180 days, and includes the following:
• Type of service
• Frequency and length of sessions
• Modality (1:1 or group)
• Identification of responsible parties
• A written description of service coordination between the two providers and the recipient during the TCL plan period, identifying the following:
• The provider staff involved in coordinating services
• The provider’s contact information
• How information will be exchanged
• The anticipated schedule for ARMHS TCL services on a weekly basis
Use MN–ITS 837P Professional to bill for all ARMHS.
Enter the treating provider NPI number on each claim line.
Use appropriate CPT modifiers if an ARMHS service is provided on the same day but at different times by any of the following:
• The same ARMHS provider
• Different ARMHS providers within the same ARMHS provider organization
• Different ARMHS provider organizations working concurrently with an ARMHS recipient
Adult Rehabilitation Mental Health Services (ARMHS) Benefits
Basic Living and Social Skills - individual; mental health professional or practitioner
Authorization is required for more than 300 hours per calendar year combined total of H2017, H2017 HM and H2017 HQ.
Basic Living and Social Skills - individual; mental health rehabilitation worker
Basic Living and Social Skills - group; mental health professional, practitioner, or rehabilitation worker
Transition to Community Living (TCL)
|• Authorization required
• Cannot be done concurrently with other ARMHS services
• No threshold
Transition to Community Living (TCL) by a mental health rehabilitation worker
mental health professional or practitioner
Authorization is required for more than 10 sessions per month or 72 sessions per calendar year.
mental health rehabilitation worker
Transition to Community Living (TCL) Intervention
|• Authorization required
• Cannot be done concurrently with other ARMHS services
• No threshold
Transition to Community Living (TCL) Intervention by a mental health rehabilitation worker
|• Authorization required for more than 24 units per calendar year
• Maximum number of units for the initial functional assessment is 14 units
• Maximum number of units for the update or review is 10 units
Functional Assessment Update/Review
Individual Treatment Plan
|• Authorization required for more than 14 units per calendar year
• Maximum number of units for the initial ITP is 8 units
• Maximum number of units for the update or review ITP is 6 units
Individual Treatment Plan Update/Review
Medication Education – individual; physician, registered nurse, physician’s assistant or a pharmacist
Authorization is required for more than 26 hours per calendar year of H0034 and 26 hours per calendar year of H0034 HQ
Medication Education – group; physician, registered nurse, physician’s assistant or a pharmacist
Minnesota Statutes 256B.0623
Minnesota Rule 9505.2175 subp 1 & 2
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