Level of Care Assessment and Necessity of Care Recommendation or Referral

Revised: November 13, 2023

· Overview

· Level of Care Assessments and Necessity of Care Recommendation or Referral

· Eligible Providers

· Treatment Supervision

· Clinical Justification for Exceptions

· Time Frames for an assessment to be “Current”

· Time Frames for a Necessity of Care Recommendation or Referral to be “Current”

· Legal References

Overview

A level of care assessment and necessity of care recommendation or referral helps determine the resource intensity needs of individuals who receive adult mental health services. The mental health provider must complete a level of care assessment or necessity of care recommendation or referral before delivering the following MHCP services:

· Adult Day Treatment (ADT)

· Adult Rehabilitative Mental Health Services (ARMHS)

· Assertive Community Treatment (ACT)

· Intensive Rehabilitative Mental Health Services (IRMHS)

· Intensive Residential Treatment Services (IRTS)

· Partial Hospitalization (PHP)

· Children’s Intensive Behavioral Health Services

Level of Care Assessments and Necessity of Care Recommendation or Referral

Level of care assessment tools must be appropriate to the member’s age.

Members 5 years old or younger:

· Early Childhood Service Intensity Instrument (ESCII)

Members 6 to 17 years old:

· Child and Adolescent Service Intensity Instrument (CASII)

Members 18 years old or older:

· Level of Care Utilization System (LOCUS) (American Association for Community Psychiatry webpage)

· Necessity of Care Recommendation or Referral

Necessity of Care Process
The mental health professional must complete both of the following:

· Verify and document that the member meets all of the eligibility criteria for a particular service recommendation or referral; and

· Make a recommendation or referral using clinical judgment for the clinically appropriate service and document it within the client’s diagnostic assessment.

Refer to the Necessity of Care Service Recommendation Referral FAQs for additional information about the Necessity of Care Service Recommendation or Referrals process.

Providers can email ScreeningToolCommittee.LOC.dhs@state.mn.us for technical assistance with the level of care assessments or Necessity of Care Recommendation or Referral policy.

Eligible Providers

Refer to the program links listed under Overview to determine eligible providers for these services.

Treatment Supervision

All level of care assessments must be reviewed and approved by a treatment supervisor, unless it is completed by a mental health professional or a certified rehabilitation specialist.

Clinical Justification for Exceptions

MHCP requires documented clinical justification for additional services. A mental health professional or clinical trainee can justify this by completing a necessity of care process within a diagnostic assessment. The written clinical justification must include how the additional services currently meet or will meet the individual’s resource intensity needs. Include a brief description of the variance in the assessment and include a more in-depth description in the member’s medical record. This can be on a separate form or as part of a clinical summary (if completed by the MH professional).

Time Frames for a Level of Care Assessment to be “Current”

At the time of admission into the program or as specified by the individual service line, a level of care assessment recently completed by another provider, agency or county may be used. A new assessment is not required if all of the following apply:

· The member provides appropriate permission; and

· The assessment has been completed within 30 days before admission; and

· The clinical supervisor reviews the assessment and determines there are no changes to the assessment of the member since the original assessment was completed; or

· A necessity of care recommendation or referral was completed by a mental health professional with a current diagnostic assessment.

The clinical supervisor can decide to complete a new level of care assessment at the time of admission.

A level of care assessment is valid for a maximum of 180 days (six months) from the date it is approved by the mental health professional. Complete a new assessment:

· At the 180-day limit

· More frequently if required for the service being provided

· If there has been a significant change in the member’s functioning

· If significant life events have occurred

If the member ends services without notice and leaves before a discharge level of care assessment can be completed, indicate in the discharge summary or elsewhere why the discharge assessment was unable to be completed.

Time Frames for a Necessity of Care Recommendation or Referral to be “Current”

A necessity of care recommendation or referral is valid for the entire time that the diagnostic assessment is valid. A necessity of care recommendation or referral may be added to a diagnostic assessment sometime after the diagnostic assessment was completed, so long as the diagnostic assessment is still valid. A separate level of care assessment is not required if necessity of care is documented in a client’s valid diagnostic assessment.

Legal References

Minnesota Statutes 245.461 to 245.468 (Minnesota Comprehensive Adult Mental Health Act)
Minnesota Statutes 245.462 (Definitions)
Minnesota Statutes 245I.02, subdivision 19 (Level of care assessment)