Adult Residential Crisis Stabilization (RCS)

Revised: January 21, 2025

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization Requirements

· Billing

· Legal References

Overview

Adult residential crisis stabilization (RCS) provides structure and support to an adult member in a community living environment when a member has experienced a mental health crisis and needs short-term services to ensure that the member can safely return to the member’s home or pre-crisis living environment with additional services and supports identified in the member’s crisis assessment. Residential crisis stabilization is provided in a 24-hour licensed residential setting by qualified mental health staff. Residential crisis stabilization serves eligible members assessed during a crisis assessment to be experiencing a mental health crisis.

Eligible Providers

Eligible providers must be enrolled with MHCP. Before enrolling with MHCP, each residential crisis stabilization (RCS) site must have a statement of need and meet the following provider standards:

All RCS programs

Statement of need
Each site must have either a statement of need from the local mental health authority or an approved need determination from the Minnesota Department of Human Services (DHS) commissioner.

The statement of need must include the following:

· Geographic area and population to be served by the proposed program

· Proposed program capacity, including number of beds for residential crisis stabilization services

· Evidence of ongoing relationships with other service providers that the RCS will use for referrals to and from the proposed program

· Statement from the local mental health authority indicating whether the local mental health authority supports or does not support the need for the proposed program and the basis for this determination

If the provider entity does not receive a response from the local mental health authority within 60 days of requesting, the commissioner will use the following need-determination process:

· The provider will submit, to the Behavioral Health Administration, relevant information to demonstrate need of the proposed program, including the provider’s communication with the local mental health authority and the provider’s statement of need

· If available, the commissioner will review the current needs assessment provided by the local Adult Mental Health Initiative, other stakeholder input provided by tribal behavioral health programs, mobile crisis teams, individuals, families, communities, health plans and hospitals

· The commissioner will make a determination of need and notify the proposed provider within 60 days of receipt of required information

Submit the statement of need, or information for the need-determination process, to the Behavioral Health Administration at DHS.AdultMHAct_IRTS@state.mn.us.

Standards for all RCS programs
All providers, regardless of bed size or license type, must have the following standards:

· Support for member’s family and natural supports

· Ability to ensure availability of services

· Staff qualified, trained, and competent to provide mental health crisis response services

· Culturally specific treatment identified in the crisis treatment plan

· Flexibility to respond to the changing interventions and care needs of members

· Ability for staff to communicate and consult about crisis assessment and interventions

· Coordination with community services

· Crisis intervention services consistent with the Minnesota Comprehensive Adult Mental Health Act

· Ability to coordinate detoxification or withdrawal management services

· A quality assurance and evaluation plan to evaluate the outcomes of services and member satisfaction

Programs with capacity for five or more beds
Providers must comply with the following requirements:

· Licensed by DHS Licensing to provide residential crisis stabilization according to Minnesota Statutes 245I

· Not exceed 16 beds

· Have a rate approved by DHS. Review the Service rates information webpage.

Programs with capacity for four or fewer beds
Providers must comply with the following requirements:

· Licensed by DHS Licensing to provide adult services in a supervised residential setting

· Staffed with a mental health professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner at least eight hours per day when an RCS member is present

· Utilize a statewide per diem rate for services

Note: Applicants who plan to enroll as an MHCP provider must complete the licensing process with DHS Licensing and the MHCP rate setting process with the Behavioral Health Administration before MHCP enrollment. Receiving an IRTS or RCS license does not guarantee rate approval and does not expedite the MHCP rate setting process.

Eligible Members

To be eligible for RCS services, an MHCP member must meet all of the following:

· Be 18 years old or older

· Be eligible for MHCP

· Crisis assessment indicating the member is experiencing a mental health crisis. The crisis assessment must be completed by a physician, mental health professional, or a qualified member of the mobile crisis team

Covered Services

The following services must be available and offered as part of the program design:

· 24-hour on-site staff and assistance

· Assessment of the member’s immediate needs and factors that lead to the crisis

· Daily crisis stabilization services to restore the member to a pre-crisis level of functioning based on the member’s crisis treatment plan

· Individual abuse prevention plan

· Rehabilitative mental health services

· Health services including medication administration

· Room and board (for members enrolled in Medical Assistance only)

· Room and board is covered for members enrolled in MinnesotaCare major programs by the managed care organization

· Referrals to other service providers in the community as needed and to support the member’s transition from RCS

· Crisis response action plan if a crisis should occur

Noncovered Services

The following services are noncovered from reimbursement under RCS:

· Services delivered to a member admitted to an inpatient hospital

· Transportation services

· Mental health crisis response services provided and billed by a non-MHCP provider

· Services provided by a volunteer

· Outreach services to potential members

· Non-medically necessary mental health services

· Partial hospitalization or day treatment

· Crisis assessment that a residential provider completes when billing the daily rate for RCS

Authorization Requirements

Authorization is needed to exceed the maximum threshold of 10 days in a calendar month. To request authorization, submit an MHCP Authorization Form (DHS-4695) (PDF) with the following supporting documentation:

· Crisis assessment

· Crisis stabilization treatment plan and progress notes

· Discharge plan or plans for transitioning to the community, including referrals to other service providers (services are coordinated after the member leaves the program)

· Symptoms that have not returned to the member’s baseline level

· Other options considered, including hospitalization and community crisis stabilization

· Written explanation of why the member needs more time and the anticipated outcome

Billing

MHCP will reimburse RCS for up to 10 days, based on a daily rate per provider. When billing for RCS, refer to the following:

· Bill only direct mental health service days; do not bill for days when direct services were not provided

· Use the MN–ITS 837P to bill the treatment procedure code H0018

· Use the MN-ITS 837I to bill for room and board revenue code 1001

· Include the date of admission.

· Type of Bill (TOB) 86X. Refer to the Adult Residential Crisis Stabilization (RCS) Room & Board Services MN–ITS user guide.

· Value Code 24

· Enter the five-digit code 90018

· Value Code 80

· Enter the number of days for covered inpatient days

· Value Code 81

· Enter the number of days for noncovered inpatient days

· Bill room and board for direct mental health service days only

· Bill room and board service days for MinnesotaCare members to the appropriate health plan

Description of codes and limitations

Code	Description	Units	Limitations
H0018	Adult crisis stabilization, residential	1 day	Authorization is required for more than 10 days in a calendar month. Do not submit claims with individual provider number.
1001	Room and board	1 day	Authorization is not required

Legal References

Minnesota Statutes, 256B.0624, Adult Crisis Response Services Covered
Minnesota Statutes, 245.461 to 245.486, Minnesota Comprehensive Adult Mental Health Act
Minnesota Statutes, 245F, Withdrawal Management
Minnesota Statutes, 245I.01 to 245I.13 and 245I.23, Mental Health Uniform Service Standards
Minnesota Rules, 9505.0322, Mental Health Case Management Services
Minnesota Rules, 9530.6605 to 9530.6655, Detoxification services