Hospital In-Reach Service Coordination (IRSC)

Revised: September 15, 2020

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Billing

· Legal References

Overview

Minnesota Health Care Programs (MHCP) covers hospital in-reach service coordination (IRSC) to reduce instances of emergency department (ED) and other non-medically necessary health care use. Hospital IRSC brings together health care and community-based services for MHCP members for up to 60 days after hospital discharge. It includes helping members find services to address dental, mental and chemical health, housing, transportation, employment, peer support services, and other health, social and economic needs. IRSC can connect the member with existing covered services available to them, such as targeted or waiver case management, or care coordination in a health care home.

Eligible Providers

Hospitals may employ or contract with the following individual providers or community-based providers to provide hospital IRSC:

· Clinical nurse specialist, mental health specialty (CNS MH)

· Licensed independent clinical social worker (LICSW)

· Licensed marriage and family therapist (LMFT)

· Licensed professional clinical counselor (LPCC)

· Licensed psychologist (LP)

· Nurse practitioner

· Physician

· Physician assistant (PA)

Enrolled Community-Based Providers

MHCP-enrolled community-based providers need to sign and submit a Community-based Providers for IRSC – Applicant Assurance Statement (DHS-3898) (PDF) to MHCP so their records indicate they are IRSC program participants.

In-Reach Service Coordinators

Eligible in-reach service coordinators must hold a minimum of a bachelor’s degree in social work, public health, corrections or a related field.

Eligible Members

Before performing the assessment, MHCP recommends that providers determine if the member is already receiving services that would make them ineligible for participation in in-reach care coordination.

Members receiving the following services are not eligible for participation:

· Health care homes

· Mental health targeted case management

· A health care delivery system demonstration project

IRSC is available to members of any age with three or more emergency department (ED) visits in the previous four consecutive months.

The qualifying ED services and inpatient stays are not limited to a single hospital. Clinicians may use the MN–ITS User Guide Health Information Request (HIR) clinical tool to access a more complete medical history for MHCP members. The HIR clinical tool can help prevent duplication of services.

If multiple providers deliver IRSC one or more days during a 60-day service period, MHCP will reimburse all providers for the initial assessment; however, only the provider whose claim is filed first with the state will be reimbursed for the follow-up continuing service.

Children Diagnosed with Severe Emotional Disturbance (SED)

Members under the age of 21 who are diagnosed with SED are eligible for IRSC services if they meet one of the following criteria:

· Have visited a hospital emergency department two or more times in the previous consecutive three months

· Are admitted to an inpatient psychiatric unit two or more times in the previous consecutive four months

· Are being discharged from either an ED or an inpatient psychiatric unit to a shelter

Members enrolled in MA or MinnesotaCare programs are eligible for hospital IRSC services.

Members enrolled in the following programs are not eligible for MHCP hospital IRSC services:

AC EH FP HH IM QM

Alternative Care Emergency Medical Assistance (except for pending appeals) Family Planning HIV/AIDS Institution for Mental Disease Qualified Medicare Beneficiary

Covered Services

MHCP covers hospital IRSC performed through a hospital ED. This includes working with other providers to connect eligible members with existing MHCP-covered services, community-based services and other resources available to them.

The provider must perform an initial assessment of the member to evaluate:

· Mental and chemical health needs

· Housing needs

· Transportation needs

· Employment needs

· Family or peer support services needs

· Other health, dental, social, educational, and economic needs, including an assessment of other services for which the member may be eligible or receiving, such as targeted or waiver case management, or care coordination in a health care home

Follow-up services after the initial assessment include working with other providers to coordinate treatment to help the member access a variety of services. Services under IRSC focus on reducing the number of visits to a hospital ED or inpatient readmissions for non-medically necessary health care. These services must address the member’s needs determined in the initial assessment. Services may be provided in the member’s place of residence or by phone.

Hospital IRSC may be provided for up to 60 days from the discharge date of the ED visit or of the inpatient hospital stay that resulted from an ED visit and is:

· Limited to two non-overlapping 60-day periods per calendar year, if there are a minimum of three or more ED visits or inpatient admitting events that resulted from an ED visit in the previous consecutive months

· Limited to a total of 80 hours across one or both 60-day periods

Reimbursement Period

The 60-day service reimbursement period begins:

· On the date of the initial assessment for members identified in the emergency department

· On the date of discharge from the hospital for members identified during their hospitalization

Noncovered Services

The following services are not covered under hospital IRSC:

· Services for more than 80 hours within a calendar year

· More than two non-overlapping 60-day occurrences within a calendar year

· Other existing covered services (for example, transportation, housing, mental and chemical health services)

Billing

· Use the electronic 837P Professional claim format

· Use procedure code T1016 with modifier U2 for the initial hospital IRSC assessment

· Use procedure code T1016 with modifier U2 and TS for follow-up hospital IRSC services

· Services are billable in 15-minute unit increments

· Use the hospital National Provider Identifier (NPI) as the billing provider

· Report the NPI of the treating professional; if the services are provided by an in-reach service coordinator, report the NPI of the supervising professional as the treating provider

Managed Care Organizations (MCOs)

Submit claims for MCO enrollees to the appropriate prepaid MCO.

Legal References

Minnesota Statutes, 256B.0625, subdivision 56 (Covered Services; Medical service coordination)