Mental Health Services

Revised: September 22, 2025

· Overview

· Covered Services

· Eligible Providers

· Eligible Members

· Units (bases for measurement)

· Outcome Measures Reporting

· Noncovered Services

· Legal References

Overview

Minnesota’s publicly provided mental health system, as reflected in the Mental Health Uniform Service Standards Act and the Minnesota Comprehensive Mental Health Acts, is supervised by Minnesota Department of Human Services (DHS) and administered by counties. Counties act as the local mental health authority. Review the General MHCP Non-Enrollable Mental Health Provider Requirements webpage for information about criteria to be an eligible Minnesota Health Care Programs (MHCP) mental health provider.

Covered Services

Providers may deliver some mental health services by Telehealth. Review the Mental Health Codes, Maximum FFS Rates, and Eligible Providers chart.

The following are covered mental health services (refer to the linked sections for additional service-specific information):

· Crisis Services

· Adult and Children's Crisis Response Services

· Adult and Children’s Mental Health Targeted Case Management

· Outpatient Mental Health Services

· Adult Day Treatment

· Children’s Intensive Behavioral Health Services

· Children’s Mental Health Clinical Care Consultation

· Diagnostic Assessment (DA)

· Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP)

· Explanation of Findings

· Family Psychoeducation

· Mental Health Provider Travel Time

· Neuropsychological Services

· Partial Hospitalization Program

· Psychotherapy

· Psychological Testing

· Psychotherapy for Crisis

· Telehealth Delivery of Mental Health Services

· Treatment Supervision

· Rehabilitative Mental Health Services

· Adult Day Treatment

· Adult Rehabilitative Mental Health Services (ARMHS)

· Assertive Community Treatment (ACT)

· Certified Family Peer Services

· Certified Peer Specialist Services

· Children’s Therapeutic Services and Supports (CTSS)

· CTSS Children’s Day Treatment

· Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS)

· Residential Treatment

· Adult Residential Crisis Stabilization (RCS)

· Children’s Mental Health Residential Treatment

· Intensive Residential Treatment Services (IRTS)

· Psychiatric Residential Treatment Facility (PRTF)

· Physician Mental Health Services

· Extended Inpatient Psychiatric Services

· Health and Behavior Assessment/Intervention

· Inpatient Visits

· Physician Consultation, Evaluation and Management

· Psychiatric Consultations to Primary Care Providers

Components of Mental Health Service Delivery

· Diagnostic assessment

· Functional assessment (Adult)

· Level of care assessment (Adult)

· Individual treatment plan (ITP)

· Service delivery

· Reassessment

Eligible Providers

Mental health providers include agencies and individual professionals. Each mental health agency must have at least one mental health professional on staff. Other agency staff may be eligible to provide services but not eligible to enroll as MHCP providers (review the General MHCP Non-Enrollable Mental Health Provider Requirements webpage).

When qualified state staff provide mental health services, they are considered part of the certified local provider entity, and their services may be billed according to typical billing practices as appropriate to the specific service.

Mental Health Professionals

The following mental health professionals may enroll with MHCP:

· Licensed independent clinical social worker (LICSW)

· Licensed marriage and family therapist (LMFT)

· Licensed professional clinical counselor (LPCC)

· Licensed psychologist (LP)

· Certified psychiatry or osteopathic physician

· Nurse practitioner (NP)*

· Clinical nurse specialist (CNS)*

· Tribal-certified professional

Mental Health Providers

The following are not eligible to enroll as an MHCP provider (refer to the General MHCP Non-Enrollable Mental Health Provider Requirements section of the MHCP Provider Manual):

· Mental health practitioner

· Certified rehabilitation specialist

· Clinical trainee

· Mental health certified peer specialist

· Mental health certified family peer specialist

· Mental health rehabilitation worker

· Mental health behavioral aide (CTSS only)

· Mental health case manager or case manager associate

General Treatment Supervision Requirements

MHCP has more than one mental health treatment supervision standard:

· Refer to Treatment Supervision for requirements on supervision of diagnostic assessment, psychotherapy and explanation of findings.

· Refer to the Specialty Specific Mental Health Supervision Requirements chart and specific covered services sections for other supervision requirements.

Medicare Enrollment Denials

When Medicare denies enrollment as a Medicare provider, the following MHCP providers must submit the Mental Health Professional Applicant Assurance Statement – Medicare Enrollment Denial (DHS-3864) (PDF) to MHCP Provider Enrollment. Inform MHCP immediately when Medicare approves enrollment.

· LICSW

· LPs with Education level 2 (doctoral degree) and cannot enroll with Medicare

· Nurse Practitioner or Certified Nurse Specialist with mental health specialty

· Providers that are not eligible to enroll with Medicare may provide services to MHCP members, including dually eligible members. When requesting authorization of mental health services, notify the medical review agent that the treating provider is not eligible to enroll with Medicare.

Right to Appeal Denial of Certification or County Contract

Providers required to be certified by or contracted with a county as part of the criteria to become an authorized provider of mental health services may appeal a county refusal to grant the necessary contract or certification. A member may initiate an appeal on behalf of a provider-denied certification. Either members or providers may submit a request for a review of the county decision to the Behavioral Health Division by either fax or mail to the following:

Fax:	651-431-7566 (Attn: Behavioral Health Appeal Review)
Mail:	DHS Behavioral Health Division – Appeal Review P.O. Box 64981 540 Cedar St. St. Paul, MN 55164-0981

Eligible Members

Members eligible to receive mental health services must be eligible for MHCP and Health Care Programs and Services.

A resident of an Institution for Mental Disease (IMD) is eligible to receive MA services only if the member is receiving inpatient psychiatric care in an accredited psychiatric facility and meets one of the following criteria:

· Is under 21 years old

· Is 21 years old, but less than 22 years old and has been receiving inpatient psychiatric care in the IMD continuously since the resident’s 21st birthday

· Is at least 65 years old

Members 21 years old and older, but under 65 years old, who reside in an IMD are eligible to receive outpatient mental health services. Inpatient mental health services are only eligible through the IMD. If discharged within 180 days, the member is eligible to receive case management services through relocation service coordination (RSC). Contact the managed care organization (MCO) if the member is receiving services through the MCO.

Most mental health services have member eligibility requirements that require the member to meet the criteria in one or more of the following definitions:

Child with emotional disturbance: A child with an organic disorder of the brain, or a clinically significant disorder of thought, mood, perception, orientation, memory or behavior that meets both of the following:

· Is detailed in a diagnostic code list published by the commissioner

· Seriously limits a child’s capacity to function in primary aspects of daily living, such as personal relations, living arrangements, work, school and recreation

Mental Illness: An organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory or behavior that meets both of the following:

· Is detailed in a diagnostic code list published by the commissioner

· Seriously limits a person’s capacity to function in primary aspects of daily living such as personal relations, living arrangements, work and recreation

For children younger than 6 years old, trained professionals can refer to the current edition of the DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood published by Zero to Three.

Emotional disturbance means an organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that:

· is detailed in a diagnostic codes list published by the commissioner; and

· seriously limits a child’s capacity to function in primary aspects of daily living such as personal relations, living arrangements, work, school, and recreation.

“Emotional disturbance” is a generic term and is intended to reflect all categories of disorder described in the clinical code list published by the commissioner as "usually first evident in childhood or adolescence."

Serious mental illness (SMI): SMI is when a child with emotional disturbance meets one of the following criteria:

· Has been admitted to inpatient or residential treatment within the last three years or is at risk of being admitted

· Is a Minnesota resident and receiving inpatient or residential treatment for an emotional disturbance through the interstate compact

· Has been determined by a mental health professional to meet one of the following criteria:

· Has psychosis or clinical depression

· Is at risk of harming self or others as a result of emotional disturbance

· Has psychopathological symptoms as a result of being a victim of physical or sexual abuse or psychic trauma within the past year

· Has a significantly impaired home, school or community functioning lasting at least one year or presents a risk of lasting at least one year, as a result of emotional disturbance, as determined by a mental health professional

Serious and persistent mental illness (SPMI): A condition with a diagnosis of mental illness that meets at least one of the following:

· The member had two or more episodes of inpatient care for mental illness within the past 24 months

· The member had continuous psychiatric hospitalization or residential treatment exceeding six months’ duration within the past 12 months

· The member has been treated by a crisis team two or more times within the past 24 months

· The member has a diagnosis of schizophrenia, bipolar disorder, major depression or borderline personality disorder; evidences a significant impairment in functioning; and has a written opinion from a mental health professional stating he or she is likely to have future episodes requiring inpatient or residential treatment unless community support program services are provided

· The member has, in the last three years, been committed by a court as a mentally ill person under Minnesota statutes, or the adult’s commitment as a mentally ill person has been stayed or continued

· The member was eligible under one of the criteria listed under SPMI, but the specified time period has expired

· The member was eligible as a child with serious mental illness, and the member has a written opinion from a mental health professional, in the last three years, stating that he or she is reasonably likely to have future episodes requiring inpatient or residential treatment of a frequency described in the above criteria, unless ongoing case management or community support services are provided

Refer to Relocation Services Coordination Targeted Case Management section of the MHCP Provider Manual for more information.

Units (bases for measurement)

In the case of time as part of the code definition, follow HCPCS and CPT guidelines to determine the appropriate units of time to report. Per the guidelines, providers must spend more than half the time of a time-based code performing the service to report the code. If the time spent results in more than half the defined value of the code, and no additional time increment code exists, round up to the next whole number. Any other claim submission for services provided during the remaining balance of the unit of time is duplicative and ineligible. Review the following unit of measurement examples:

15-minute example

Minutes	Units
0 – 7	None
8 – 15	1

30-minute example

Minutes	Units
0 – 15	None
16 – 30	1

60-minute example

Minutes	Units
0 – 30	None
31 – 60	1

Outcome Measures Reporting

The Minnesota Department of Human Services (DHS) requires regular reporting of client outcomes information for publicly funded mental health services using the Mental Health Information System (MHIS) for adults, and the Children’s Mental Health (CMH) Outcome Measures Reporting System for adolescents. DHS uses this information in the analysis of those services to assist in policy development, program management, services administration and federal mandated reporting.

Mental Health Information System (MHIS): DHS requires MHCP mental health service providers to use MHIS for adult members. MHIS provides two methods of reporting: an individual web-based data entry and batch submissions of data. For more information on reporting criteria, batch reporting resources, and to sign up to receive MHIS email updates or join the MHIS monthly user call, visit the MHIS technical assistance webpage.

CMH Outcome Measures Reporting System: DHS requires mental health service providers to use CMH for children’s services. Find technical assistance and contact and other information for the CMH Outcome Measures Reporting System in the Children’s Mental Health Outcome Measures Reporting System User Manual.

Noncovered Services

The following are not covered MHCP mental health services:

· Mileage (provider travel time is not the same as mileage)

· Transporting a member

· Telephone calls that do not follow all Telehealth Delivery of Mental Health Services requirements

· Written communication between provider and member

· Reporting, charting and record keeping (these activities are considered part of providing services)

· Community planning or consultation; program consultation, monitoring and evaluation; public information; training and education activities; resource development and training activities

· Fund-raising

· Court-ordered services for legal purposes only

· Mental health services not related to the member’s diagnosis or treatment for mental illness

· Services dealing with external, social or environmental factors not directly addressing the member’s physical or mental health

· Staff training

· Mental health case management for members receiving similar services through the Veterans Administration (VA)

· Duplicate services

· Mental health services provided by an entity whose purpose is not health service related (for example, services provided by the Division of Vocational Rehabilitation or Jobs and Training)

· Legal services, including legal advocacy, for the member

· Information and referral services included in the county’s community social service plan

· Outreach services through the community support services program

· Assistance in locating respite care, special needs day care, and assistance in obtaining financial resources, except when these services are eligible under a mental health covered service.

· Client outreach

· Recreational services, including sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack times, trips to community activities, etc.

Legal References

Minnesota Statutes, 147 Board of Medical Practice (for psychiatrist licensure requirements)
Minnesota Statutes, 148 Public Health Occupations
Minnesota Statutes, 148.171 – 148.285 Minnesota Nurse Practice Act
Minnesota Statutes, 148.88 – 148.98 Minnesota Psychology Practice Act
Minnesota Statutes, 148.907 Licensed Psychologist
Minnesota Statutes, 148.925 Supervision
Minnesota Statutes, 148B.29 to 148B.39 Marriage and family therapy
Minnesota Statutes, 148D.055 Board of Social Work, License Requirements
Minnesota Statutes, 245 Department of Human Services
Minnesota Statutes, 245I Mental Health Uniform Service Standards Act
Minnesota Statutes, 245.461 – 245.486 Adult Mental Health Act
Minnesota Statutes, 245.487 – 245.4887 Children’s Mental Health Act
Minnesota Statutes, 245.4889 – 245.490 Children’s Mental Health Grants
Minnesota Statutes, 245.491 – 245.90 Children’s Mental Health Integrated Fund
Minnesota Statutes, 256B Medical Assistance for Needy Persons (includes covered mental health services)
Minnesota Statutes, 256B.0671 Covered Mental Health Services
Minnesota Statutes, 256L.03 MinnesotaCare, Covered Health Services
Minnesota Rules, 9505 Health Care Programs
Minnesota Rules, 9505.0322 Mental Health Case Management Services
Minnesota Rules, 9505.0540 Criteria for Readmissions
Minnesota Rules, 9505.2175 – 9505.2180 Health Service Records, Financial Records, Access to Records
Minnesota Rules, 9505.5000 – 9505.5105 Conditions for MA and GAMC Payment
Minnesota Rules, 9520 Mental Health Services
Minnesota Rules, 9520.0900 – 9520.0926 Case Management for Children with Severe Emotional Disturbance (SED) (Rule 79)
Minnesota Rules, 9535.4068 Standards for Family Community Support Services for Children with SED and their Families (Rule 15)
Code of Federal Regulations title 42, 435.1008 – 1009 (IMD) FFP in expenditures for medical assistance for individuals who have declared United States citizenship or nationality; Institutionalized individuals
Code of Federal Regulations title 42, 440.60(a) Medical or other remedial care provided by licensed practitioners
Code of Federal Regulations title 42, 440.160 Inpatient psychiatric services for individuals under age 21
Code of Federal Regulations title 42, 440.170(e) Any other medical care or remedial care recognized under State law and specified by the Secretary, Emergency hospital services
Code of Federal Regulations title 42, 440.230 Sufficiency of amount, duration, and scope
Title XIX, Section 1915(g) of the Social Security Act (MH-TCM)