Mental Health in Special Education (MH-SPED) are mental health services within an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP). These services are covered Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services when deemed medically necessary and provided to youth by qualified providers through an IEP or an IFSP. A Summary and Recommendations (S&R) using clinical assessments for and within a special education evaluation and IEP or IFSP determines medical necessity for specific covered mental health services within special education.

Eligible Providers

Services must be provided by the following school staff within the scope of practice for each service area and as defined in Minnesota Statutes, 245I.04, subdivision 2.

· Mental health professional

· Mental health practitioner under the treatment supervision of a mental health professional

· Clinical trainee under the treatment supervision of a mental health professional

Provider Responsibilities

Providers play an active role in the planning, delivery, and monitoring of MH-SPED to effectively meet the student’s individualized mental health needs. As members of the special education team, mental health professionals are responsible for the identification of mental health needs and service recommendations for students through clinical assessment for and within the IEP or IFSP.

Providers are responsible for the following:

· Determining medically necessary mental health services congruent with the student’s identified need, area of concern, or disorder.

· Ensuring service recommendations and treatment planning are based on assessments and clinical determination of need.

· Reviewing the IEP or IFSP if serving as a treatment plan at a minimum of every 180 days.

· Communicating and engaging with caregivers to support services and goals as appropriate.

· Maintaining required documentation of all interactions and services.

· Collaborating with other service providers internally and externally as appropriate.

· Providing treatment supervision including developing a treatment supervision plan for staff according to Minnesota Statutes, 245I.06. A treatment supervisor must be available for urgent consultation as required by the student’s needs or the situation.

Eligible Members

Eligible members must be actively enrolled in one of the major Medical Assistance (MA) or MinnesotaCare programs and meet the following requirements:

· Must be under 22 years old and have not graduated high school unless otherwise identified under a specific service.

· Must have a current IEP or IFSP that identifies the covered health-related service to be provided.

Refer to MHCP Member Eligibility for more information about the major program codes.

Refer to MHCP Benefits-at-a-glance for major program codes for MHCP covered services.

Covered Services

Explanation of Findings

Definition: The purpose of explanation of findings is to discuss the results of the assessment, psychological tests and other accumulated data, make service recommendations, and conduct treatment planning. Refer to Explanation of Findings under the Mental Health Services in the Minnesota Health Care Programs (MHCP) Provider Manual for more information.

Coverage: This service is provided to students, students’ family and caregivers or other natural supports to help them better understand the areas of concern, diagnosis, or focus of treatment and provide professional insight needed to carry out a IEP or IFSP or treatment plan as per Minnesota Statutes, 256B.0671, subdivision 4. Limitations of services may apply. Explaining test results as part of the assessment and evaluation process is not a separate billable service.

Documentation: Documentation of this service must be clearly identified in the student’s progress notes. Refer to Progress Notes for further details.

Provider: Mental health professionals and clinical trainees under the treatment supervision of a mental health professional.

Psychotherapy for Crisis

Definition: Psychotherapy for crisis services help to reduce a mental health crisis through immediate assessment and psychotherapeutic interventions. An intervention of psychotherapy for crisis will diminish the suffering of the student in crisis and help restore life functioning. Refer to Psychotherapy for Crisis under Mental Health Services in the MHCP Provider Manual for more information.

Coverage: Medical assistance covers psychotherapy for crisis situations where individuals are at immediate risk of harm or severe impairment due to increased mental health symptoms. Specific interventions are covered. Psychotherapy for crisis must include emergency assessment of the crisis, mental status exam, intervention, and development of a post-crisis plan to support the individual and prevent future crises.

Documentation: Documentation of this service must be clearly identified in the student’s progress notes. Refer to Progress Notes. Documentation for this service includes additional information including:

· Factors that make the mental health crisis life threatening or complex

· History of the crisis

· Results of the mental status exam

· Recipient’s coping skills used to reduce the crisis

· Community resources used

· Psychotherapy techniques and interventions used and the recipient’s response

· Protective and risk factors that influenced the outcome of the intervention

· Reason for the services chosen

· Steps taken to ensure the recipient’s safety after the intervention

Provider: Mental health professionals or clinical trainees under the treatment supervision of a mental health professional.

Children's Mental Health Clinical Care Consultation

Definition: Children’s mental health clinical care consultation involves communication between the student's mental health provider and other providers or educators working with the child to share information, strategies, and treatment goals to improve overall care. Refer to Children’s Mental Health Clinical Care Consultation under Mental Health Services in the MHCP Provider Manual for more information.

Coverage: Medical assistance covers clinical care consultation for children under 21 with complex mental health conditions or co-occurring conditions, as outlined in their treatment plan.

Documentation: Documentation of this service must be clearly identified in the student’s progress notes. Refer to Progress Notes.

Provider: Mental health professionals and clinical trainees under the treatment supervision of a mental health professional

Dialectical Behavior Therapy (DBT)

Definition: An evidence-based intensive outpatient treatment program (IOP) for adolescents ages 12 to 17 that uses rehabilitative and psychotherapeutic interventions. Treatment combines individual and group sessions, phone coaching, and weekly team meetings to treat mental health conditions that cannot otherwise be met with other services and recipient must be at significant risk. Refer to Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) under the Mental Health Services in the MHCP Provider Manual for more information.

Components of DBT must include all of the following:

· Individual therapy: One-on-one sessions to address specific behavioral targets.

· Group skills training: Teaches mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. 24 to 26 weeks a minimum of two hours a week.

· Telephone coaching: Provides support between therapy sessions.

To qualify for DBT, a student must have severe mental health concerns with specific diagnostic criteria, as identified through assessments and DBT team determination, unable to be managed with other standard services, and be at significant risk of crisis, harm to themselves or others, decompensation or a higher level of care. Student must be cognitively capable of participating in DBT as an intensive therapy program and be willing to follow program policies and rules to ensure the safety of self and others.

Coverage: DBT is covered as an intensive mental health outpatient treatment. Concurrent services may be prohibited, and prior and ongoing authorization is required. Providers must report student outcomes to the state.

Documentation: DBT authorization, assessments, collaterals and required components of progress notes must be individually documented. Refer to Progress Notes. For this service, documentation must also identify functional deficits and progress in identified IOP targeted areas against baseline level of functioning before intervention. Documentation of outcomes must be reported to the State.

Provider: DBT programs and providers must meet specific criteria and be certified by the State. Certified DBT IOP teams and their teams through employment, contract or affiliation with the DBT IOP program are eligible providers. Certified DBT IOPs must meet all certification standards and submit proof through an application and on-site review.

Child and Family Psychoeducation Services

Definition: Child and family psychoeducation includes individual, family, or group skills development or training, designed to facilitate the acquisition of psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate developmental trajectory disrupted by a mental health condition, or diagnosis to enable the child to self-monitor, compensate for, cope with, counteract, or replace skills deficits and build on strengths. Interventions which include skill development may be provided individually, in family sessions, or peer group settings. Group skills training can be offered to multiple children with similar needs. Refer to Child and Family Psychoeducation Services under the Mental Health Services in the MHCP Provider Manual for more information.

Coverage: Child and family psychoeducation services can be provided to a child up to age 21 and the family members when determined to be medically necessary due to a mental health condition, or diagnosis and targeted needs as identified in the child's individual treatment plan, IEP or IFSP. Child and Family psychoeducation units or sessions are subject to the same calendar year, cumulative limits as psychotherapy.

Documentation: Documentation of this service must be clearly identified in the student’s progress notes. Refer to Progress Notes. For service providers qualified as clinical trainees and mental health practitioners, the treatment supervisor must review and approve the completed progress notes for this service. Refer to Treatment Supervision.

Provider: Mental health professionals, clinical trainees, and mental health practitioners. Clinical trainees and mental health practitioners must be under the treatment supervision of a mental health professional.

Psychotherapy

Definition: Treatment of a person that applies the most appropriate psychological, psychiatric, psychosocial or interpersonal method that conforms to prevailing community standards of professional practice to meet the mental health needs of the student. Psychotherapy is a planned and structured, face-to-face treatment of a student’s identified areas of concern or diagnosis, and directed to accomplish measurable goals and objectives as specified in the IEP, IFSP as the individual treatment plan (ITP). Refer to Psychotherapy under Mental Health Services in the MHCP Provider Manual for more information.

Types of psychotherapy include:

· Individual psychotherapy: Tailored treatment for a single student.

· Family psychotherapy: Involves the student and at least one family student or primary caregiver.

· Group psychotherapy: Treatment for a group of 3 to 12 students with specific staffing requirements.

· Multiple-family group psychotherapy: For two to five families, addressing the needs of each family.

Coverage: Psychotherapy is covered when deemed medically necessary and appropriate to meet the specific needs of the child.

Documentation: Documentation of this service must be clearly identified in the student’s progress notes. Refer to Progress Notes. For this service, progress notes must also include formal or informal assessment of the student’s mental health status. Refer to Psychotherapy - Documentation of Covered Service. Progress notes must be legible and signed by the provider. When the service provider qualifies as a clinical trainee, the treatment supervisor must review and approve the completed progress notes for this service. Refer to Treatment Supervision.

Provider: Mental health professional or clinical trainee under the treatment supervision of a mental health professional.

Documentation

General: Documentation of all interactions, collateral contacts and services provided is a condition of enrollment with MCHP. Failure to maintain appropriate record keeping may result in MHCP recovering funds already paid. Refer to Individualized Education Program (IEP) Services - Record Keeping and Documentation.

Medical necessity: Medical necessity for services is documented in the Summary and Recommendations (S&R). The S&R is based on clinical assessments for and within the IEP and IFSP. Refer to Determination of Medical Necessity.

Treatment planning: For MH-SPED, the IEP or IFSP may serve as the written individual treatment plan outlining a student’s needs, goals, and services. The plan must include all required elements of an individual treatment plan. A separate ITP may be completed and referenced within the IEP or IFSP. Refer to Treatment Planning.

Progress reporting: Progress towards goal attainment, changes to goals, and/or modifications to treatment approach must be reviewed and documented at a minimum of every 180 calendar days to be eligible for Medicaid reimbursement for MH-SPED. Refer to Progress Reporting.

Progress notes: All covered services rendered must be documented in a progress note for each episode of care on each date of service. A progress note must meet all documentation requirements. Refer to Progress Notes.

Treatment supervision: Treatment supervision, including the development of a written treatment supervision plan, must be provided to all clinical trainees and mental health practitioners. Supervision notes must be kept documenting the provision of treatment supervision according to the treatment supervision plan. The treatment supervisor must review and approve all documentation completed by the supervisee. Refer to Treatment Supervision.

Determination of Medical Necessity

Medical necessity for MH-SPED must be documented in writing. Medical necessity is determined by a mental health professional, or clinical trainee under the treatment supervision of a mental health professional. The medical necessity determination must include a face-to-face contact with the student, collection and review of collateral information, and clinical assessment resulting in an identified mental health need. The data is compiled or referenced within the Summary and Recommendations (S&R).

Summary and Recommendations (S&R)

Medical necessity for MH-SPED covered services is determined with the Summary and Recommendations (S&R). A medically necessary service is defined as an appropriate service congruent with a student’s identified disorder(s), signs and symptoms, and/or social determinants of health. The S&R must be completed by a mental health professional or clinical trainee under the treatment supervision of a mental health professional to be eligible for Medicaid reimbursement for these services. The S&R must be identified within the special education evaluation, IEP, or IFSP.

The S&R is completed using information gathered from direct contact with the student by the mental health professional or clinical trainee, collection and/or review of collateral information, and assessments used for and within the IEP or IFSP during the student’s special education evaluation. The mental health professional may use assessments, screenings, and evaluations completed by other qualified providers in the S&R. If used, the complete document must be included in the student’s record.

The S&R must clearly identify the specific mental health disorder(s), signs and symptoms, and/or social determinants of health (F, R, or Z ICD-10 codes) that determines the student’s eligibility for MH-SPED. This determination may consist of any of the allowable conditions in the Mental Health Diagnostic Code Ranges and ICD-10 codes. If a disorder (F code) is appropriate, the mental health professional must follow and document DSM-5 TR diagnostic criteria. Recommendations for covered services that address the identified need are also provided in the S&R. A student’s cultural and developmental context must be taken into consideration when determining service recommendations. The S&R must include the date of completion with name, credentials and signature of the mental health professional.

The S&R must include and document the following components:

· Student demographic information including name and date of birth.

· Sources of information, including special education evaluations, IEPs or IFSPs, and previously completed internal and/or external behavioral health assessments.

· Face-to-face contact with student, such as an interview or observation.

· Baseline measurements, including cognitive, emotional, and behavioral functioning.

· Responsivity factors, such as strengths, skills, vulnerabilities, safety needs, resources, and cultural considerations.

· Explanation of how the mental health need was determined using information from the identified sources, student contact, and clinical judgment of the mental health professional.

· Identification of mental health disorder(s), signs and symptoms, and/or social determinants of health. Use DSM-5 TR diagnostic criteria as appropriate.

· ICD-10 code(s) classifying the student’s identified disorder(s), condition(s), and/or area(s) of need.

· Services and supports recommended to address identified mental health need.

· Additional information as needed regarding the student’s needs and/or services to be provided.

· Date of completion, and the name, credentials and signature of the mental health professional, or qualified treatment supervisor as appropriate.

The mental health professional must review a student’s special education records to ensure the following components are present when available, which also meet the standard diagnostic assessment requirement as described in Minnesota Statutes, 256B.0625, subdivision 26.

Missing components listed below should be added as appropriate:

· Student’s age

· Student’s current living situation, including housing status and household members

· Status of student’s basic needs

· Student’s education level and employment status

· Student’s current medications

· Immediate risks to the student’s health and safety

· Student’s perceptions of the member’s condition

· Description of symptoms, including the reason for referral

· Student’s history of mental health and substance use disorder treatment

· Cultural influences on the student

· Student’s substance use history including amounts and types of substances, frequency and duration, route of administration, periods of abstinence, circumstances of relapse and impact to functioning when under the influence

· Student’s relationship to and quality of relationship with family and others

· Student’s strengths and resources, including social networks

· Important developmental incidents in the student’s life

· Maltreatment, trauma, potential brain injuries, and abuse that the student has suffered

· Student’s history of or exposure to alcohol and drug usage and treatment

· Personal and family health history, including physical, chemical, and mental health

Information must be gathered and documented related to these areas to a degree that it is reasonable and developmentally appropriate. The gathering of information should not be retraumatizing to the student or harmful to the student’s willingness to engage in services. If this information cannot be obtained, the topics requiring further assessment during treatment must continue to be documented.

Treatment Planning

For the provision of MH-SPED, the IEP or IFSP may serve as the written individual treatment plan outlining a student’s needs, goals, and services based on the Summary and Recommendations (S&R). The plan must include all required elements of an individual treatment plan as described in Minnesota Statutes, 245I.10. In addition to a mental health professional, treatment planning can be completed by a clinical trainee or mental health practitioner with oversight and approval through signature by a supervising mental health professional.

The plan should clearly identify the following:

· Identified areas of need

· Treatment goals

· Measurable treatment objectives

· Strategies and interventions for achieving identified goals and objectives

· The responsible party for each treatment component

· A schedule for services, including frequency, duration, and location

Development and implementation of a treatment plan within the IEP or IFSP must include involvement of both the student and the student’s caregivers. For MH-SPED, a mental health professional must sign the IEP or IFSP if it serves as the individual treatment plan.

Progress Reporting

The IEP or IFSP, if serving as the individual treatment plan, must be reviewed with the student’s progress, changes to goals, and/or modifications to treatment approach at a minimum of every 180 calendar days and updated as needed to be eligible for Medicaid reimbursement for MH-SPED. The IEP or IFSP may be updated more often due to a change in student’s functioning and needs. The mental health professional is responsible for the review and approval of changes made to the treatment plan, IEP or IFSP and must provide signature approval.

Progress Notes

A progress note must be used to document each occurrence of a mental health service provided to a student according to Minnesota Statutes 245I.08, subdivision 4. Failure to maintain appropriate record keeping may result in MHCP recovering funds already paid. Providers must document the service and modality rendered in a progress note for each episode of care on each date of service. A progress note must be legible and signed with credentials by provider, and treatment supervisor, when appropriate.

A progress note must include the following:

· Type of service

· Date of service

· Start and stop times of each service

· Service location

· Modality (individual, group, telehealth)

· Targeted goal and measurable objective

· Intervention provided and methods used

· Student’s response to the intervention

· Provider’s plan for future actions including changes in treatment to be implemented if interventions are ineffective

· Signature and credentials of the person who provided the service

A progress note may include the following as needed and/or required:

· Signature and credentials of a treatment supervisor if services are provided by a clinical trainee or mental health practitioner

· Formal or informal assessment of the student’s mental health status.

· Significant observations by the provider including student’s current risk factors, emergency interventions provided, consultations with or referrals to other professionals, family or significant others, and changes in the student’s mental or physical symptoms.

Treatment Supervision

Treatment supervision, as described in Minnesota Statutes, 245I.06, must be provided by a mental health professional to each mental health practitioner and clinical trainee providing and seeking Medicaid reimbursement for MH-SPED covered services. A treatment supervisor must ensure each supervisee can effectively meet students' needs. A treatment supervisor must provide supervision according to the supervisee’s written treatment supervision plan.

The treatment supervisor must review and approve all completed documentation including progress notes. Approval is provided through the supervising mental health professional’s signature with credentials. Supervision notes must be kept documenting the provision of treatment supervision according to the treatment supervision plan.

Supervisors are responsible for the following:

· Evaluate supervisee's interventions and student progress.

· Provide guidance on alternative treatment approaches if a student is not achieving treatment goals.

· Review all documentation for accuracy and appropriateness.

· Educate about student cultures and how they impact treatment.

· Offer feedback on performance and provide training.

· Conduct supervision in-person, by phone, or video for timely feedback.

· Document treatment changes resulting from supervision in student records.

· Document the provision of treatment supervision to each supervisee.

Treatment Supervision Plan

A written treatment supervision plan must be developed by the treatment supervisor and the supervisee within 30 days of employment and updated annually or more frequently as needed.

Each treatment supervision plan must include the following:

· The name and qualifications of the person receiving treatment supervision.

· The names and licensures of the treatment supervisors who are supervising.

· The frequency of treatment supervision to the supervisee.

· The supervisee’s authorized scope of practice, including a description of the population served and a description of the treatment methods and modalities that may be used to provide services to students.

· The supervisor is responsible for all services delivered by their supervisee and must be available for consultation.

Noncovered Services

The only MH-SPED services eligible for reimbursement are listed under Covered Services.

Noncovered services include the following:

· Service components simultaneously provided by multiple providers within the same agency.

· Activities that may be offered by a provider but are not otherwise eligible for reimbursement such as universal social emotional learning programs provided to the school.

Billing

Review the IEP Billing and Authorization Requirements for more information regarding billing for these services.

All services provided under an IEP or IFSP must be individually tracked documenting date, time, and modality for reporting and audit purposes. The district is responsible for tracking and reporting mental health services delivered in the school setting. Refer to Individualized Education Program (IEP) Services - Record Keeping and Documentation for more information. Tracking and reporting of individual mental health services provided in a school setting is the responsibility of the enrolled school provider.

Legal References

Minnesota Statutes, 245I.04, subdivision 2 (Mental health professional qualifications)
Minnesota Statutes, 245I.06 (Mental Health Uniform Service Standards, Treatment Supervision)
Minnesota Statutes, 245I.10, subdivision 8 (Individual treatment plan, required elements)
Minnesota Statutes, 256B.0625, subdivision 26 (Covered Services, Special education services)
Minnesota Statutes, 256B.0671 (Covered Mental Health Services)

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