Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP)

Revised: March 20, 2023

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Authorization

· Concurrent Therapy

· Billing

· Legal References

Overview

Dialectical behavior therapy intensive outpatient program (DBT IOP) is a treatment program that uses an evidence-based treatment approach which utilizes a combination of individualized rehabilitative and psychotherapeutic interventions. DBT IOP involve: weekly individual therapy, weekly group skills training, telephone coaching, and weekly consultation team meetings.

Eligible Providers

Certified DBT IOP teams and their team members through employment, contract or affiliation with the DBT IOP program are eligible providers.

Eligible Teams

To be eligible to bill for DBT IOP services, each DBT IOP team must be certified through the Minnesota Department of Human Services (DHS). Review the Dialectical Behavior Therapy webpage for information on the certification application process.

Each team comprises, at a minimum:

· A team leader who is an enrolled mental health professional with a specialty in DBT

· Two other individual treating providers trained in DBT

Certified DBT IOPs must meet all certification standards and submit proof through an application and onsite review to obtain a recertification and maintain eligibility.

Individual Provider Qualifications

A team leader must meet all the following requirements:

· Must be a mental health professional and be an active member of the DHS-certified DBT team by employment, contract or affiliation

· Must have appropriate competencies and working knowledge of DBT principles and practices

· Must have knowledge of and the ability to apply the principles and DBT practices that are consistent with evidence-based practices

· Best practices recommend that a team leader provide some direct services to clients through individual therapy, skills training or both

A team member must be one of the following:

· An enrolled mental health professional

· A mental health clinical trainee

· A mental health practitioner

A team member must meet all the following requirements:

· Be employed by, affiliated with or contracted by a DHS-certified DBT program

· Have appropriate competencies and knowledge of DBT principles and practices, or obtain these competencies and knowledge within the first six months of becoming part of a DBT program

· Have knowledge of and the ability to apply the principles and practices of DBT consistent with evidence-based practices, or obtain the knowledge and ability within the first six months of becoming part of a DBT program

· Participate in DBT consultation team meetings for the recommended duration of 90 minutes per week

· If the team member is a mental health practitioner or mental health clinical trainee, the team member must receive ongoing supervision from a mental health professional who has appropriate competencies and working knowledge of DBT principles and practices

A certified DBT IOP provider must complete the staff update via the DBT IOP Login webpage when the status of any team member changes. The staff update must be submitted to the site within 15 days of the change occurring within the team. To fill out the Staff Update Application, you must use your unique MN–ITS login and password, which are used to access the online certification and recertification applications for DBT IOPs.

Eligible Members

All eligible MHCP members must:

· Have mental health needs that cannot be met with other available community-based services or that need services provided concurrently with other community-based services

· Understand and 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

· Be at significant risk of one or more of the following, as recorded in the member’s record:

· A mental health crisis

· A need for a higher level of care, such as hospitalization or partial hospitalization

· Decompensation of mental health symptoms

· Intentional self-harm (suicidal and non-suicidal) or risky impulsive behavior or be currently having chronic self-harm thoughts or urges (suicidal or non-suicidal) although the person has managed to not act on them. People with chronic self-harm thoughts and urges are at a greater risk of decompensation

An MHCP member must meet all of the following admission criteria to receive Adult DBT:

· Be 18 years or older

· Have either:

· a diagnosis of borderline personality disorder; or

· multiple mental health diagnoses and is exhibiting behaviors characterized by impulsivity or intentional self-harm behavior and is at significant risk of death, morbidity, disability or severe dysfunction across multiple life areas

An MHCP member must meet all of the following admission criteria to receive Adolescent DBT:

· Be 12-17 years old

· Have either:

· a diagnosis of disruptive mood dysregulation disorder or borderline personality disorder; or

· other mental health diagnoses including, but not limited to, a substance-related and addictive disorder

· Have documented assessment information showing functional deficits in three of five of problem areas:

· Emotional dysregulation

· Impulsivity (including avoidance)

· Interpersonal problems

· Teenager and family challenges

· Reduced awareness and focus

To remain in DBT, an MHCP adult or adolescent member must meet all of the following continued-stay criteria:

· Be actively participating and engaged in the DBT program, its treatment components and its guidelines according to treatment team expectations

· Have made demonstrable progress as measured against the member’s baseline level of functioning before the DBT intervention. Examples of demonstrable progress include:

· Decreased self-destructive behaviors

· Decreased acute psychiatric symptoms with increased functioning in activities of daily living

· Objective signs of increased engagement

· Reduced number of acute care services, such as emergency department (ED) visits, crisis services and hospital admissions

· Application of skills learned in DBT to life situations

· Continue to make progress toward goals but have not fully demonstrated an internalized ability to self-manage and use learned skills effectively

· Be actively working toward discharge, including concrete planning for transition and discharge

· Have a continued need for treatment as indicated in the preceding continued-stay criteria and by ongoing documented evidence in the member’s record

To be discharged from DBT, an MHCP adult or adolescent member must meet one of the following discharge criteria:

· The member has met individual treatment plan goals and objectives, or no longer meets continuing-stay criteria

· The member’s thought, mood, behavior or perception has improved to a level for which a lesser level of service is indicated

· The member chooses to discontinue the treatment contract

· The provider concludes the member will no longer benefit from DBT services after a clinical assessment

· The provider will complete paperwork and refer the member to needed services

Covered Services

Individual DBT

Individual DBT is a combination of individualized rehabilitative and psychotherapeutic interventions to treat suicidal and other dysfunctional coping behaviors and to reinforce the use of adaptive skillful behaviors by:

· Identifying, prioritizing and sequencing behavioral targets

· Treating behavioral targets

· Generalizing dialectical behavior therapy skills to members’ natural environment by providing DBT IOP telephone coaching outside of scheduled office hours, 24 hours a day, 7 days per week while observing therapist’s limits

· Measuring progress toward dialectical behavior therapy targets

· Managing crisis and life-threatening behaviors

· Helping members learn and apply effective behaviors in working with other treatment providers. If someone other than the individual therapist provides phone coaching, that person must be another member of the DBT IOP team trained in phone coaching protocol.

The DBT IOP is required to provide individual DBT by a qualified member of the certified team for the recommended duration of one hour per week. One of the following qualified team members may provide individual DBT:

· Mental health professional

· Mental health clinical trainee

DBT Group Skills Training

DBT IOP group skills training is a combination of individualized psychotherapeutic and psychiatric rehabilitative interventions conducted in a group format to reduce suicidal and other dysfunctional coping behaviors and restore function through teaching adaptive skills modules.

Adult DBT Training Skills Groups
Adult DBT Training Skills Groups consist of 2-10 members. The standard treatment for adults includes the completion of two cycles. One cycle lasts 24-26 weeks. Groups consist of one cycle which includes the following four modules:

· Mindfulness

· Personal effectiveness

· Emotion regulation

· Distress tolerance

Adolescent DBT Training Skills Groups
Adolescent DBT Training Skills Groups consist of 3-5 families. The standard treatment for adolescents includes the completion of one cycle, which lasts 24-26 weeks. Groups consist of one cycle which includes the following five modules. Parenting DBT Skills Groups are included in the treatment for adolescents.

· Mindfulness

· Interpersonal effectiveness

· Emotional regulation

· Distress tolerance

· Walking the Middle Path (specific for parents and adolescents)

DBT IOP must provide group skills training for a minimum of two hours a week with the option to last up to two and a half hours. Review the Dialectical Behavior Therapy webpage for more information.

A combination of any of the following qualified team members may provide group skills training:

· Two mental health professionals

· One mental health professional co-facilitating with one mental health clinical trainee

· One mental health professional working with one mental health practitioner

A mental health professional or clinical trainee must determine and indicate the need for individual DBT skills training (delivered outside a group setting) on the prior authorization form before delivering the service.

Authorization

All DBT IOP services require prior authorization. Request authorization in six-month increments.

A recommendation for DBT IOP must be based on a comprehensive assessment which includes the following:

· a diagnostic assessment

· a functional assessment

· a review of the member’s prior treatment history by the DBT IOP team to determine that DBT IOP services are medically necessary.

The treatment supervisor must review comprehensive evaluations completed by a clinical trainee.

Initial authorization for DBT-IOP

Complete and submit the following for initial authorization:

· MHCP Authorization Form (DHS-4695) (PDF)

· MHCP Initial DBT Authorization Form (DHS-6322) (PDF)

Authorization for additional DBT-IOP services

Complete and submit the following to request authorization for additional units of service:

· Authorization Form (DHS-4695) (PDF)

· MHCP Additional DBT Authorization Form (DHS-6322A) (PDF)

Submit the additional authorization request within 10 days of completing the units initially authorized. Do not submit an authorization request for a span of time that overlaps a previously authorized span.

Concurrent Therapy

Outpatient family therapy can be provided during the same time frame with DBT IOP. Prior authorization is required for outpatient family therapy. If outpatient family services are provided on the same day as DBT IOP without authorization, MHCP will make an adjustment to pay the DBT IOP provider first and take back payment from the unauthorized service.

Refer to Coordination of Services on the Billing Policy Overview section of the MHCP Provider Manual.

Exclusionary services
Adults and Adolescents
DBT cannot be provided at the same time with the following services:

· Outpatient individual therapy (including under CTSS umbrella)

· Partial hospitalization

· Adult Day treatment or CTSS Children’s Day Treatment

· Intensive Treatment in Foster Care

· ACT/Youth ACT

Billing

Bill using MN–ITS 837P.

Enter the rendering provider NPI number on each claim line.

Use the following table for billing DBT IOP services.

DBT Benefits: All Services Require Prior Authorization
Code	Modifier	Brief Description	Units	Service Limitation
H2019	U1	Individual DBT therapy for adults	15 min.	Up to 26 hours (104 units) per six months A one-time authorization for up to an additional 78 units for prolonged exposure protocol
H2019	U1 HA	Individual DBT therapy for adolescents	15 min.
H2019	U1 HN	Individual DBT therapy for adults by clinical trainee	15 min.
H2019	U1 HN HA	Individual DBT therapy for adolescents by a clinical trainee	15 min.
H2019	U1 HQ	Group DBT skills training for adults	15 min.	Up to 78 hours (312 units) per six months
H2019	U1 HQ HA	Group DBT skills training for adolescents	15 min.
H2019	U1 HQ HN	Group DBT skills training for adults by clinical trainee	15 min.
H2019	U1 HQ HN HA	Group DBT skills training for adolescents by a clinical trainee	15 min.

Legal References

Minnesota Statues 245I Mental Health Uniform Service Standards Act
Minnesota Statues 256B.0671, subdivision 6 Dialectical behavior therapy
Minnesota Statutes 245I.10 Assessment and Treatment Planning
Minnesota Statutes 245I.20 Mental Health Clinic