Children’s Mental Health Crisis Response Services

Revised: March 5, 2021

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Crisis Assessment

· Crisis Intervention

· Crisis Stabilization

· Noncovered Services

· Billing

· Definitions

· Legal References

Overview

Children’s mental health crisis response services are intensive face-to-face, short-term mental health services initiated during a crisis to help the child or youth return to their baseline level of functioning. A mobile crisis response team must provide children’s crisis response services outside of inpatient hospital settings.

Eligible Providers

A crisis response provider must be a county or tribe, or have a contract with a county or tribe.

A mobile crisis intervention team must consist of:

· Two or more mental health professionals or

· At least one mental health professional and one mental health practitioner

· Certified peer specialists may provide certified peer specialist services during all phases of crisis response

Mental health practitioners, certified peer specialists and rehab workers must:

· Have completed at least 30 hours of crisis intervention and stabilization training during the past two years

· Be under clinical supervision by a Minnesota Health Care Programs (MHCP)-enrolled mental health professional who:

· Is employed by or under contract with the crisis response provider

· Accepts full responsibility for the services provided

Consult with the clinical supervisor, in person or by phone, during the first three hours the practitioner provides on-site services.

The clinical supervisor must:

· Be immediately available to staff by phone or in person

· Document consultations

· Review, approve and sign the crisis assessment and treatment plan performed by mental health practitioners within one day of the crisis visit

· Document on-site observations in the member’s record

Crisis response providers must be experienced in, and have knowledge of:

· Mental health assessment

· Treatment engagement strategies

· How to work with families and others in the member’s support system

· Crisis intervention techniques

· Emergency clinical decision-making abilities

· Local services and resources

MHCP strongly encourages MHCP-enrolled crisis response services providers to contract with each health plan in their service area. Contact the appropriate managed care organization.

Also, refer to the Greater Minnesota PMAP and MinnesotaCare Contact Grid for Mental Health and Chemical Dependency Services (DHS-4484-ENG) (PDF) for greater Minnesota PMAP and MinnesotaCare contact information for mental health and chemical dependency services.

Eligible Members

To be eligible for MHCP children’s crisis response services, an MHCP member must meet all of the following:

· Be eligible for MA

· Be under age 21

· Be experiencing a mental health crisis or emergency

· Meet the criteria for emotional disturbance (age 0-18) or mental illness (age 18 to 21)

Covered Services

Crisis response services include:

· Crisis Assessment

· Crisis Intervention

· Crisis Stabilization

Crisis Assessment

A crisis assessment is an immediate, face-to-face evaluation by a physician, mental health professional or practitioner to determine the member’s presenting situation and identify any immediate need for emergency services. The crisis assessment is meant to:

· Provide immediate intervention to provide relief of distress based on a determination that the child’s behavior is a serious deviation from his or her baseline level of functioning

· Evaluate in a culturally appropriate way and as time permits the child’s current:

· Life situation and sources of stress

· Symptoms, risk behaviors and mental health problems

· Strengths and vulnerabilities

· Cultural considerations

· Support network

· Functioning

Conduct the crisis assessment in the member’s home, the home of a family member or another community location. Determine the need for crisis intervention services or referrals to other resources based on the assessment.

*Crisis Screening

Conduct a screening of the potential crisis situation before doing crisis assessment. The screening must:

· Gather information.

· Determine whether a crisis situation exists.

· Identify the parties involved.

· Determine an appropriate response.

This is not a MHCP covered service.

Crisis Intervention

Crisis intervention is a face-to-face, short-term intensive mental health service started during a mental health crisis or emergency to help the member:

· Cope with immediate stressors and lessen his or her suffering.

· Identify and use available resources and member’s strengths.

· Avoid unnecessary hospitalization and loss of independent living.

· Develop action plans.

· Begin to return to his or her baseline level of functioning.

Crisis intervention services must be:

· Available 24 hours per day, seven days per week, 365 days per year.

· Provided at the member’s preferred site by a mobile team in a community setting unless significant safety concerns exist.

· Provided promptly.

Crisis Intervention Treatment Plan

With the child and the child’s family, develop, document and implement an initial crisis plan within 24 hours of the initial intervention to reduce or eliminate the crisis. The crisis plan must include the following:

· A list the child’s needs and problems identified in the crisis assessment

· Identified frequency and type of services to be provided

· Identified measurable short-term goals

· Specified objectives directed toward the achievement of each goal

· Noted cultural considerations

· Recommended needed services, including crisis stabilization

· Appropriate local resources referenced, such as the county social services agency, mental health services, local law enforcement

· Written clear progress notes of the outcome of goals

· If the member has a case manager, coordinate the planning of other services with the case manager

If the child shows positive change in a baseline level of functioning or a decrease in personal distress:

· Make and document a referral to less-intensive mental health services, such as CTSS; or

· Document that short-term goals have been met and that no further crisis intervention services are needed.

The child or the parent or guardian must sign the crisis plan. If the child and family refuse to approve and sign the plan, the team must note the refusal and the reasons for the refusal in the treatment plan. A mental health professional must approve and sign the treatment plan. Give a copy of the treatment plan to the member.

Note: If the services continue into a second calendar day, a mental health professional must contact the member face-to-face on the second day to provide services and update the crisis plan. For this service, “Second calendar day” means 24 hours from the beginning of the face-to-face intervention. The mental health professional is not restricted to only the professional who was supervising the service when the face-to-face intervention began.

Crisis Stabilization

Crisis stabilization services are mental health services provided to a member after crisis intervention to help the member obtain his or her functional level as it was before the crisis. Provide crisis stabilization services in the community, based on the crisis assessment and crisis plan.

Consider the need for further assessment and referrals. Update the crisis stabilization treatment plan, supportive counseling, skills training and collaboration with other service providers in the community.

Crisis Stabilization Plan
Develop a crisis stabilization plan in partnership with the child and family within 24 hours of beginning services with the participation of the member. The crisis stabilization treatment plan, at a minimum, must include:

· Problems identified in the assessment.

· Concrete, measurable short-term goals and tasks to be achieved including time frames for achievement.

· Specific objectives directed toward achieving each goal.

· Clear progress notes about outcomes of goals.

· List of member’s strengths and resources.

· Documentation of participants involved and a crisis response action plan, if another crisis should occur.

· Frequency and type of services initiated, including a list of providers, as applicable.

The child or family must sign the crisis plan. If the child and family refuse to approve and sign the plan, the team must note the refusal and the reason(s) for the refusal. A member of the crisis team must approve and sign the crisis stabilization plan. Give a copy of the plan to the member.

Noncovered Services

The following services are not covered as crisis response services:

· Member transporting services

· Crisis screening

· Crisis response services performed by volunteers

· Provider performance of household tasks, chores, or related activities, such as laundering clothes, moving the member’s household, housekeeping and grocery shopping for the member

· Time spent “on call” and not delivering services to member

· Activities primarily social or recreational in nature, rather than rehabilitative

· Job-specific skills services such as on-the-job training

· Case management

· Outreach services to potential member

· Crisis response services provided by a hospital, board and lodging, or residential facility to a resident of that facility

· Room and board

Billing

· Use MN–ITS 837P

· Bill for direct, face-to-face services provided to an eligible child by a qualified staff person

· Enter the actual place of service code (POS); POS may not be 23 (emergency department) for mobile team billing

· Enter the individual treating provider NPI

· Each team member providing on-site, face-to-face services may bill

· When an off-site team member (professional) works with an on-site team member, the professional may bill for time spent working directly with the on-site member

Child Crisis Service Billing

Code	Mod	Service Description	Unit	Additional Requirements
H2011	UA	Child crisis assessment, intervention and stabilization – individual by a mental health professional	15 min.	There are no thresholds for crisis response services provided in the community. Authorization is not required for crisis assessment, stabilization and intervention.
H2011	UA HN	Child crisis assessment, intervention and stabilization – individual practitioner	15 min.	There are no thresholds for crisis response services provided in the community. Authorization is not required for crisis assessment, stabilization and intervention.

Definitions

· Mental health crisis: A behavioral, emotional, or psychiatric situation that would likely result in significantly reduced levels of functioning in primary activities of daily living or in the placement of the member in a more restrictive setting.

· Mental health emergency: A behavioral, emotional, or psychiatric situation which causes an immediate need for mental health services (for example, 911 call, emergency department visit or inpatient hospitalization).

Legal References

Minnesota Statutes 245.487 – 245.4887 (Minnesota Comprehensive Children's Mental Health Act)
Minnesota Statutes 256B.0943 (Children’s Therapeutic Services and Supports)
Minnesota Statutes 256B.0944 (Children’s Mental Health Crisis Response Services)