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

Revised: May 14, 2025

· Overview

· Eligible Providers

· Certification and Contract Process

· Eligible Members

· Covered Services

· Authorization

· Billing

· Legal References

Overview

Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS) is an intensive, comprehensive and nonresidential rehabilitative mental health service. Services are delivered using a multidisciplinary team approach and are available 24 hours a day, 7 days per week. Youth ACT/IRMHS teams work intensively with youth with severe mental health or co-occurring mental health and substance use issues to help them remain in their community and reduce the need for residential or inpatient placements. Teams also work with youth leaving these placements to ensure a smooth transition back to their home, family and community. Services are delivered in an age-appropriate and culturally sensitive manner designed to meet the specific needs of each member.

Eligible Providers

An eligible Youth ACT/IRMHS program must:

· Have a contract with and be certified by Minnesota Department of Human Services (DHS)

· Follow all Intensive Rehabilitative Mental Health Services (IRMHS) standards

A core Youth ACT/IRMHS team must maintain at least four full-time equivalent direct care staff which must include a:

· Mental health professional

· Co-occurring disorder specialist

· Certified Peer Specialist; and

· One of the following, credentialed to prescribe medications:

· Advanced practice registered nurse certified in psychiatric or mental health care

· Board-certified child and adolescent psychiatrist

Based on member needs, the team may also include:

· Additional mental health professionals

· A vocational specialist

· An educational specialist

· A child and adolescent psychiatrist retained on a consultant basis

· Mental health practitioners

· Clinical trainees

· Case management service provider

· A housing access specialist

· A family peer specialist

Additional Team Members
A treatment team may include, in addition to the at least four full-time equivalent direct care staff and others based on member needs, ad hoc team members not employed by the team who consult on a specific member and who must accept overall clinical direction from the treatment team for the duration of the member's placement with the treatment team. Ad hoc team members must be paid by the provider agency at the rate for a typical session by the agency or at a rate negotiated with the ad hoc team member. Ad hoc team members may include, but are not limited to:

· the mental health professional treating the member before entering the Youth ACT team (includes therapist or psychiatrist)

· Member’s current substance use counselor

· A lead member of the member’s individualized education program or school-based mental health provider

· A representative from the member’s tribe

· Member’s probation agent or other juvenile justice representative

· Member’s current vocational or employment counselor

· Clinical trainee

The Youth ACT/IRMHS team may only bill for services provided by these additional team members when the services are not reimbursed through another funding source. For example, the team may not bill for services provided by the school district through the individualized education plan (IEP), as these services are reimbursed separately.

Certification and Contract Process

Providers must have a contract with and be certified by DHS before delivering Youth ACT/IRMHS. Visit the Intensive Rehabilitative Mental Health Services webpage for additional information or email the Minnesota Department of Human Services’ Behavioral Health Administration at IRMHS.DHS@state.mn.us if you have questions about certification and contracts.

Eligible Members

Minnesota Health Care Programs (MHCP) members must be 8 years old or older and under 21 years old to be eligible for Youth ACT/IRMHS and have:

· Diagnosis of serious mental illness or co-occurring mental illness and substance use disorder.

· Received a level-of-care determination and functional assessment, as defined in Minnesota Statutes, 245I.02, that indicates a need for intensive integrated intervention without 24-hour medical monitoring and a need for extensive collaboration among multiple providers; impairment and a history of difficulty in functioning safely and successfully in the community, school, home, or job. Refer to the Level of Care Assessment and Necessity of Care Recommendation or Referral section of the MHCP Provider Manual for more information.

· Likely need for services from the adult mental health system during adulthood.

· Have a current diagnostic assessment indicating the need for intensive nonresidential rehabilitative mental health services.

Covered Services

The Youth ACT/IRMHS team provides the following services:

· Individual, family and group psychotherapy

· Individual, family and group skills training

· Crisis planning

· Medication management

· Mental health case management

· Medication education

· Care coordination with other care providers

· Psychoeducation to, and consultation and coordination with, the member’s support network (with or without the member present)

· Clinical consultation to the member’s employer or school

· Coordination with, or performance of, crisis intervention and stabilization services

· Assessment of member’s treatment progress and effectiveness of services using outcome measurements

· Transition services

· Co-occurring substance use disorder treatment

· Housing access support

Services must meet the specific cultural needs of the client.

Service Standards

An individual treatment team must serve youth who are either:

· At least 8 years old or older and under 16 years of age; or

· At least 14 years old or older and under 21 years old.

The treatment team must have specialized training in providing services to the specific age group that the team serves. A provider agency may choose to serve both age groups, however, separate and independently functioning teams must be created for each age group.

Members or family members must receive at least three face-to-face contacts per week that meet the following criteria:

· Face-to face contacts must total a minimum of 85 minutes of service

· The treatment team must use team treatment, not an individual treatment model.

· Services must be age-appropriate and meet the specific needs of the client.

· The level of care and functional assessments must be updated at least every six months or before discharge from the service, whichever comes first.

Each member must have an individualized treatment plan. The treatment plan must:

· Be based on the information in the member's diagnostic assessment and baselines;

· Identify goals and objectives of treatment, a treatment strategy, a schedule for accomplishing treatment goals and objectives and the individuals responsible for providing treatment services and supports;

· Be developed after completion of the client's diagnostic assessment by a mental health professional or clinical trainee and before providing services.

· Be developed through a child-centered, family-driven, culturally appropriate planning process, including allowing parents and guardians to observe or participate in individual and family treatment services, assessments and treatment planning;

· Be reviewed at least once every six months and revised to document treatment progress on each treatment objective and next goals or, if progress is not documented, to document changes in treatment;

· Ensure that the member approves of the member's individual treatment plan unless a court orders the member's treatment plan under Minnesota Statutes, 253B.

· If the member disagrees with the member's treatment plan, the license holder must document in the member file the reasons why the member does not agree with the treatment plan. If the license holder cannot obtain the member's approval of the treatment plan, a mental health professional must make efforts to obtain approval from a person who is authorized to consent on the member's behalf within 30 days after the member's previous individual treatment plan expired. A license holder may not deny a member service during this time solely because the license holder could not obtain the member's approval of the member's individual treatment plan. A license holder may continue to bill for the member's eligible services when the member resumes services

Authorization

Refer to Authorization for general authorization policy and procedures. Authorization is required for Youth ACT/Intensive Rehabilitative Mental Health Services (IRMHS) services to exceed 156 units of service in a calendar year.

To request authorization, submit the following:

· MHCP Authorization Form (DHS-4695) (except when using MN–ITS)

· Most Current Diagnostic Assessment

· Previous and current Individual Treatment Plan

· Level-of-care determination that indicates a need for intensive integrated intervention without 24-hour medical monitoring and a need for extensive collaboration among multiple providers; impairment and a history of difficulty in functioning safely and successfully in the community, school, home, or job. Refer to the Level of Care Assessment and Necessity of Care Recommendation or Referral section of the MHCP Provider Manual for more information.

Billing

MHCP reimburses Youth ACT/IRMHS services:

· Based on one, all-inclusive daily rate

· To one provider per day

Each claim must be for a face-to-face contact. Count the following services as face-to-face when the need for the member’s absence is documented:

· Family psychoeducation

· Family psychotherapy

· Clinical consultation to school or employer

Only one agency may bill when team members are from more than one agency. The billing provider reimburses other contributing agencies. Mental health professionals acting as team members may not bill their services separately from the Youth ACT team. Travel is billed separately.

Bill Youth ACT/IRMHS program services to MHCP using MN–ITS 837P:

· Use procedure code H0040 and modifier HA

· Enter one date of service per line, one unit per day

· Do not enter a rendering provider

· Bill travel using procedure code H0046

Review the 2025 IRMHS rates on the 2025 Intensive Rehabilitative Mental Health Services - Rates Approved by DHS - Behavioral Health Division (PDF).

Contact the MHCP Provider Resource Center when Youth ACT/IRMHS claims are denied due to claims for concurrent ARMHS, CTSS, day treatment, outpatient psychotherapy or crisis response services. Resubmit the Youth ACT/IRMHS claims after the concurrent claims have been reversed.

Youth ACT and other Concurrent Services

The Youth ACT/IRMHS team must coordinate all concurrent services. When requesting authorization, clearly document medical necessity for the additional services. Include the reasons Youth ACT does not or cannot meet member’s needs (specialty service, transitional service, and so on).
Other Service	Is service included in Youth ACT/IRMHS?	Can service be provided in addition to Youth ACT/IRMHS?	Service Limitations
Mental Health-Targeted Case Management	Yes	No	Case management functions are bundled in the Youth ACT/IRMHS rate. CMH-TCM is covered only in the month of admission or discharge from Youth ACT/IRMHS. CMH-TCM must request authorization for coverage other than month of admission or discharge.
Children’s Mental Health Day Treatment	No	When authorized	Day Treatment program must request authorization. If Youth ACT/IRMHS team approves Day Treatment, Youth ACT/IRMHS team must provide a statement to the Day Treatment provider for authorization request purposes. Day Treatment providers may not be additional Youth ACT/IRMHS team members. Day Treatment providers must accept clinical direction from the Youth ACT/IRMHS team.
Children’s Residential Treatment Services	No	No	Cannot be billed separately. No authorization required.
Partial Hospitalization	No	Yes	Partial hospitalization thresholds and limitations apply.
Intensive Residential Treatment Services	No	Yes	Youth ACT/IRMHS and IRTS may be provided concurrently without authorization.
Children’s Therapeutic Services and Supports and Adult Rehabilitative Mental Health Services	Yes	No	Rehabilitative skills training is a component of Youth ACT/IRMHS services, cannot be billed separately.
Mental Health Behavioral Aide Services	No	No	Cannot be billed separately.
Crisis Assessment and Intervention (mobile)	Yes	No	A component of Youth ACT/IRMHS. Team must provide or contract with a crisis provider for this service. Cannot be billed separately. No authorization required.
Crisis Stabilization – Nonresidential	Yes	No	A component of Youth ACT/IRMHS. Cannot be billed separately. No authorization required.
Crisis Stabilization – Residential	No	Yes	Service limits apply. Services must be coordinated between the Youth ACT/IRMHS and residential crisis providers.
Medication Management	Yes	No	Provided by physician or advanced practice registered nurse team members.
Outpatient Psychotherapy	Yes	No	A component of Youth ACT/IRMHS. Cannot be billed separately. No authorization required.
Inpatient Hospitalization	No	Yes	Inpatient hospitalization services are reimbursed separately from Youth ACT/IRMHS.
Waivered Services	No	Yes	County must approve concurrent care.
Other medical services (for example, PCA)	No	Yes	Service limits apply to each service.

Legal References

Minnesota Statutes, 245I.011
Minnesota Statutes, 256B.0947