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Department of Human Services Department of Human Services  
 
CTSS Children’s Day Treatment

Revised: 01-14-2013


CTSS children’s day treatment is a site-based, structured mental health treatment program. It consists of psychotherapy and skills training services.

Day treatment services:

• Are provided by a multidisciplinary team, under the clinical supervision of a mental health professional
• Are available twelve months of the year
• Stabilize the child’s mental health status
• Develop and restore the child’s independent living and socialization skills
• Provide training to enable the child to live in the community
• Are not part of inpatient or residential treatment services

Eligible CTSS Children’s Day Treatment Providers
Children’s and adult day treatment services have different certifications, standards, and limitations.

Eligible children’s day treatment providers are:

• Licensed outpatient hospitals with JCAHO accreditation
• MHCP-enrolled community mental health centers
• County agencies
• IHS/638 facilities
• Entities under contract with a county or tribe to operate a program meeting requirements under Minnesota law. Children’s day treatment providers, including school districts (certified under option 2 or 3), must submit an application and receive certification under CTSS.

Programs must provide adequate staffing and facilities to:

• Promote recipient health
• Ensure a safe environment
• Protect recipient rights
• Implement each recipient’s individual treatment plan (ITP)

Clinical Supervision
For children’s day treatment programs, the supervisor must:

• Be a licensed and MHCP enrolled mental health professional
• Be present and available on the premises more than 50 percent of the time, in a five-working-day period, when the mental health practitioner is providing a mental health service
• Approve and sign the recipient's diagnosis, ITP, and any change to either
• Review and sign the recipient’s record, every 30 days, indicating the recipient’s services for the previous 30 day period were reviewed and remain appropriate for the recipient’s condition
• Be available for urgent consultation as required by the recipient’s needs or situation

Clinical supervision may occur individually or in a group setting to discuss treatment and review progress toward goals. Note: a clinical trainee must receive clinical supervision in accordance with clinical supervision requirements specified in Minnesota Rules 9505.0371.



Eligible Recipients
Eligible recipients for CTSS children’s day treatment are:

• Under age 18 and diagnosed with an emotional disturbance (ED) or meet severe emotional disturbance (SED) criteria
• Between ages 18 and 21 and diagnosed with a mental illness (MI) or meet serious and persistent mental illness (SPMI) criteria
• Need the intensity level of day treatment as identified in the diagnostic assessment

Recipients admitted to children’s day treatment must be in need of and have the capacity to understand and benefit from the rehabilitative nature, structured setting and therapeutic components of the program’s psychotherapy and skills activities. Recipients who do not have, or cease to have, the cognitive capacity to benefit from day treatment services, may benefit from day habilitation or other services under a waiver program. Refer recipients in need of other services to the county human service agencies, school or private agencies.

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


Covered Services
Day treatment is distinguished from day care by the structured therapeutic program that uses CTSS service components:

• Psychotherapy - provided by a mental health professional or a mental health practitioner qualified as a clinical trainee
• Skills training - individual or group, provided by a mental health professional or mental health practitioner

The day treatment program must be available:

• No less than:
• One day per week
• Two hours per day
• No more than:
• Three hours per day
• 15 hours per week
• As described in the recipient’s ITP

Per available day, psychotherapy must be provided for:

• No less than one hour
• No more than 2 hours, with the remaining time including skills training

Interactive children’s day treatment may use physical aids and nonverbal communication to overcome communication barriers because the recipient demonstrates one of the following:

• Has lost or has not yet developed either the expressive language communication skills to explain his/her symptoms and response to treatment
• Does not possess the receptive communication skills needed to understand the mental health professional if he/she were to use adult language for communication
• Needs an interpreter, whether due to hearing impairment or because the recipient’s language is not the same as the provider’s

Documentation Requirements
Document the provision of each of the service components. You may use a daily checklist with the services summarized weekly. A checklist must show all of the following:

• Date of service
• Actual clock time with recipient
• Service provided (skills training, psychotherapy)
• Who provided the service
• ITP goal(s) worked on
• Weekly summary of progress toward ITP goals

Non-covered Services
CTSS day treatment does not cover mental health behavioral aide (MHBA) services. MHBAs are not an eligible provider of CTSS day treatment services.

CTSS does not cover services that are:

• The responsibility of a residential or program license holder, including foster care
• In violation of medical assistance policy
• Treatment by multiple providers within the same agency at the same clock time
• MHBA services provided by a personal care assistant who is not qualified as a MHBA and employed by a certified CTSS provider entity
• Primarily recreation oriented or provided in a setting that is not medically supervised (such as sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours)
• A social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the child’s emotional disturbance
• Consultation with other providers or service agency staff about the care or progress of a child
• Prevention or education programs provided to the community
• Treatment for recipients with primary diagnoses of alcohol or other drug abuse or traumatic brain injury

Authorization
Refer to Authorization for general authorization policy and procedures. For CTSS day treatment services, authorization is required:

• To exceed 150 hours per calendar year (separate from CTSS 200 hour limit)
• When there is a need to provide day treatment services concurrent with other services

Billing
• Bill children’s day treatment services online using MN–ITS 837P
• Enter the treating provider NPI number on each claim line
• Use procedure code H2012
• Use modifier HK to indicate children’s day treatment
• Use modifier UA to indicate CTSS

CTSS Children’s Day Treatment
Code Modifier Description Unit Limitations
H2012 UA
HK
Behavioral Health Day Treatment 1 hour Daily limit – minimum 2 hours, maximum 3 hours (may not obtain authorization for more day treatment hours in a day)

Weekly limit - maximum 15 hours per week (may not obtain authorization for more day treatment hours in a week)

Calendar year threshold – maximum 150 hours per calendar year without authorization
H2012 UA
HK
U6
Behavioral Health Day Treatment (interactive) 1 hour Daily limit – minimum 2 hours, maximum 3 hours (may not obtain authorization for more day treatment hours in a day)

Weekly limit - maximum 15 hours per week (may not obtain authorization for more day treatment hours in a week)

Calendar year threshold – maximum 150 hours per calendar year without authorization

Legal References
MS 256B.0943 (CTSS)
MN Rules
9535.4068
(continuing education for practitioner)
MN Rules 9505.0370
, 9505.0371, 9505.3072 (Outpatient Mental Health Services)


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