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Intensive Residential Treatment Services (IRTS)

Revised: 05-16-2018

  • Eligible IRTS Providers
  • Eligible Recipients
  • IRTS Admission Criteria
  • IRTS Continuing Stay Criteria
  • IRTS Discharge Criteria
  • Covered Services
  • Authorization
  • Language Interpreter Services
  • Billing
  • Legal References
  • Intensive residential treatment services (IRTS) are time-limited mental health services provided in a residential setting. Recipients of IRTS are in need of structure and assistance from 24-hour mental health staff and at risk of significant functional deterioration if they do not receive these services. IRTS are designed to develop and enhance the following:

  • • Psychiatric stability
  • • Personal and emotional adjustment
  • • Self-sufficiency
  • • Skills to live in a more independent setting
  • IRTS must be:

  • • Directed to a targeted discharge date with specified recipient outcomes
  • • Consistent with evidence-based practices
  • Eligible IRTS Providers

    An IRTS facility must comply with the following:

  • • Be licensed with the Rule 36 Variance (PDF)
  • • Not exceed 16 beds
  • • Have a contract with the host county agency, which approves the IRTS service
  • • Have a rate approved by DHS
  • IRTS treatment team members must be qualified in one of the following mental health professional roles:

  • Mental health practitioner
  • Certified peer specialist
  • Mental health rehabilitation worker
  • • Registered nurse who is also qualified as a mental health practitioner
  • IRTS providers must have:

  • • Sufficient staff for 24-hour delivery of mental health services, as described in the recipient’s individual treatment plan (ITP)
  • • Staff available to safely monitor and assist with activities of recipients
  • • The capacity to respond to emergent needs and make staffing adjustments to assure the health and safety of recipients. This includes providing medical services directly (through its own medical staff) or indirectly (through referral to medical professionals)
  • Treatment staff must have prompt access, in person or by telephone, to a mental health professional or a qualified mental health practitioner. An IRTS provider must ensure that the program meets the following minimum requirements:

  • • Staff are available to provide guidance and monitoring whenever recipients are present in the facility
  • • Staff remain awake during all work hours
  • • A staffing ratio of at least one staff to nine recipients each day and evening shift
  • • At least one staff member is a mental health professional or practitioner if more than nine recipients are present
  • Eligible Recipients

    An eligible IRTS recipient must meet the following:

  • • Be 18 years old or older
  • • Be eligible for MA
  • • Meet the IRTS admission criteria
  • Individuals who are 17 years old and transitioning to adult mental health services may be considered for IRTS if the service is determined to best meet their needs. IRTS providers must secure a licensing variance in this situation.

    Recipients may receive IRTS instead of hospitalization, if appropriate.

    IRTS Admission Criteria

    Admit a recipient to IRTS when a mental health professional determines the recipient meets the following:

  • • Has a primary diagnosis of mental illness as determined by a diagnostic assessment
  • • Has a completed functional assessment using the domains specified in statute and have three or more areas of significant impairment in functioning
  • • Has a completed LOCUS assessment where a Level 5 is indicated
  • • Is reasonably expected to commence or resume illness management and recovery skills or strategies at this level of service
  • • Needs a 24-hour supervised, monitored and focused treatment approach to improve functioning and avoid relapse that would require a higher level of treatment
  • • Is not responsive to an adequate trial of active treatment at a less intensive level of care
  • • Is at risk of significant functional deterioration if IRTS are not received
  • • Has one or more of the following:
  • • History of two or more inpatient hospitalizations in the past year
  • • Significant independent living instability
  • • Homelessness
  • • Frequent use of mental health and related services yielding poor outcomes in outpatient or community support treatment
  • The professional may consult with the recipient’s:

  • • Mental health case manager
  • • County advocate
  • • Spouse, family member or significant other (with recipient’s consent)
  • IRTS Continuing Stay Criteria

    Continue the recipient’s stay in IRTS when a mental health professional determines the recipient meets all of the following criteria:

  • • The recipient’s mental health needs cannot be met by other less intensive community-based services
  • • The recipient continues to meet admission criteria as evidenced by active psychiatric symptoms and continued functional impairment
  • • Documentation indicates that symptoms are reduced, but discharge criteria have not been met
  • • The essential goals are expected to be accomplished within the requested time frame
  • • Attempts to coordinate care and transition the recipient to other services have been documented
  • IRTS Discharge Criteria

    Discharge a recipient from IRTS when the recipient meets at least one of the following:

  • • No longer meets continuing stay criteria
  • • Has met ITP goals and objectives
  • • Shows evidence of decreased impairment and appropriate, less restrictive community-based alternatives exist
  • • Has symptoms and needs that permit a lesser level of service and adequate supports and services are in place
  • • Is voluntarily involved in his or her ITP and no longer agrees to participate in the IRTS services
  • • Exhibits severe exacerbation of symptoms, decreased functioning, disruptive or dangerous behaviors and requires a more intensive level of service
  • • Has medical or physical health needs that exceed what can be brought into the residential treatment setting
  • • Does not participate in the program despite multiple attempts to engage him or her and to address nonparticipation issues
  • • Does not make progress toward treatment goals and there is no reasonable expectation that progress will be made
  • • Leaves against medical advice for an extended period (determined by written procedures of provider agency)
  • Covered Services

    Plan and coordinate IRTS with the local mental health service delivery system. Recipients may access and receive services from the program outside of the facility when it would benefit the continuity of treatment and transition to the community. The following services must be available and offered as part of the program design:

  • • Supervision and direction
  • • Individualized assessment and treatment planning
  • • Crisis assistance, development of health care directives and crisis prevention plans
  • • Nursing services
  • • Interagency case coordination
  • • Transition and discharge planning
  • • Living skills development, including:
  • • Medication self-administration
  • • Healthy living
  • • Household management
  • • Cooking and nutrition
  • • Budgeting and shopping
  • • Using transportation
  • • Employment-related skills
  • • Integrated dual diagnosis treatment (mental health and substance abuse screening and assessment, with a team approach. Assesses treatment readiness, uses motivational interviewing and a non-confrontational approach)
  • • Illness management and recovery (educating about mental illness and treatment including characteristic symptoms and early warning signs of relapse, managing stress and developing relapse prevention plans, developing coping skills and strategies for coping with symptoms, developing social skills to improve effectiveness in interactions across a range of settings and situations, and identifying therapeutic and rehabilitative approaches available to recipients, such as DBT or treatment for OCD)
  • • Family education (services to educate, inform, assist and support family members in mental health illness and treatment, coping mechanisms, medication, community resources)
  • Authorization

    Providers must request authorization for services exceeding the 90-day limit.

    If a recipient is readmitted to an IRTS within 15 days of discharge, the readmission counts toward the 90-day limit.

    To request authorization, submit the following:

  • MHCP Authorization Form (DHS-4695) (PDF) (except when using MN–ITS)
  • Adult Mental Health Rehabilitative Services Authorization Form (DHS-4159A) (PDF)
  • • Most current diagnostic assessment
  • • Current functional assessment
  • • Current interpretive summary
  • • LOCUS
  • Language Interpreter Services

    All providers must provide language interpreter services to comply with MHCP Access Services. Providers may either include the cost of interpreter services in the cost-based per diem rate or bill for the service separately. If billing interpreter services separately, then authorization to exceed the allowable number or hours may be granted through the Adult Mental Health Division at 651-431-2225.


    MHCP will reimburse IRTS for up to 90 days, based on a daily rate per provider. When billing for IRTS, refer to the following:

  • • Bill only direct mental health service days; do not bill for days when direct services were not provided
  • • Bill for date of admission; do not bill for date of discharge
  • • Use the MN–ITS 837P
  • • Use procedure code H0019
  • Description of procedure code and limitations






    Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem

    1 day

    Maximum 90 days
    Readmission within 15 days counts toward 90-day limit
    Request authorization for more than 90 days

    IRTS & other concurrent services and limitations

    When requesting authorization, clearly document medical necessity for the additional service(s), including reasons IRTS does not or cannot meet recipient’s needs (for example, specialty service, transitional service). All services provided concurrently with IRTS must be coordinated with IRTS.

    Other service

    Is service included in IRTS

    Can service be provided in addition to IRTS?

    Service limitations




  • • Rule 79 applies
  • • IRTS must coordinate with recipient’s case manager
  • Day treatment


    Only with authorization

    • Day treatment provider must coordinate the plan of care with the IRTS provider and seek authorization for any day treatment services provided on the same day

    Partial hospitalization


    Only with authorization

  • • IRTS provider must coordinate the plan of care with the partial hospitalization provider and seek authorization for any IRT services provided on the same day
  • • Partial hospitalization thresholds and limitations apply
  • ACT



  • • Providers must clearly document the distinct services being delivered as identified in the individual’s treatment plan for each service


    Only with authorization

  • • ARMHS thresholds and limits apply to each service
  • • For Transition to Community Living (TCL) services, follow Authorization Requirements for TCL Services
  • Crisis response services (assessment or intervention only) (mobile)



  • • May be billed separately
  • • No authorization required
  • Crisis stabilization - Nonresidential



  • • A component of IRTS
  • • Cannot be billed separately
  • Crisis stabilization - residential



  • • A component of IRTS
  • • Be aware of recipient transfers
  • • If recipient is approved for IRTS and residential crisis stabilization, bill only one approved daily rate. Only one of these two services can be billed for a recipient per day
  • Psychiatric physician services



  • • May be provided by physician, psychiatric NP, CNS-MH, or physician extender if a member of the treatment staff
  • • Bill separately only if not included in IRTS rate
  • • This service component is not excluded from telemedicine delivery
  • Outpatient psychotherapy



    • Outpatient psychotherapy limits apply

    • Providers must clearly document the distinct services being delivered as identified in the individual’s treatment plan for each service

    Inpatient hospitalization



  • • Inpatient hospitalization services are reimbursed separately from IRTS
  • • IRTS may not be reimbursed for recipients admitted to an inpatient hospital
  • Interpreter services



  • • Bill separately only if not included in IRTS rate
  • Waivered services



  • • Prohibited by Federal Waiver Plan
  • Other medical services



  • • Service limits apply to each service
  • Legal References

    Minnesota Statutes 256B.0622, Intensive Rehabilitative Mental Health Services
    Minnesota Statutes 245.461 to 245.486
    , Adult Mental Health Act
    Minnesota Rules 9505.0322, Mental Health Case Management Services

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