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9505.0371 MEDICAL ASSISTANCE COVERAGE REQUIREMENTS FOR OUTPATIENT MENTAL HEALTH SERVICES.

Subpart 1.

Purpose.

This part describes the requirements that outpatient mental health services must meet to receive medical assistance reimbursement.

Subp. 2.

Client eligibility for mental health services.

The following requirements apply to mental health services:

A.

The provider must use a diagnostic assessment as specified in part 9505.0372 to determine a client's eligibility for mental health services under this part, except:

(1)

prior to completion of a client's initial diagnostic assessment, a client is eligible for:

(a)

one explanation of findings;

(b)

one psychological testing; and

(c)

either one individual psychotherapy session, one family psychotherapy session, or one group psychotherapy session; and

(2)

for a client who is not currently receiving mental health services covered by medical assistance, a crisis assessment as specified in Minnesota Statutes, section 256B.0624 or 256B.0944, conducted in the past 60 days may be used to allow up to ten sessions of mental health services within a 12-month period.

B.

A brief diagnostic assessment must meet the requirements of part 9505.0372, subpart 1, item D, and:

(1)

may be used to allow up to ten sessions of mental health services as specified in part 9505.0372 within a 12-month period before a standard or extended diagnostic assessment is required when the client is:

(a)

a new client; or

(b)

an existing client who has had fewer than ten sessions of psychotherapy in the previous 12 months and is projected to need fewer than ten sessions of psychotherapy in the next 12 months, or who only needs medication management; and

(2)

may be used for a subsequent annual assessment, if based upon the client's treatment history and the provider's clinical judgment, the client will need ten or fewer sessions of mental health services in the upcoming 12-month period; and

(3)

must not be used for:

(a)

a client or client's family who requires a language interpreter to participate in the assessment unless the client meets the requirements of subitem (1), unit (b), or (2); or

(b)

more than ten sessions of mental health services in a 12-month period. If, after completion of ten sessions of mental health services, the mental health professional determines the need for additional sessions, a standard assessment or extended assessment must be completed.

C.

For a child, a new standard or extended diagnostic assessment must be completed:

(1)

when the child does not meet the criteria for a brief diagnostic assessment;

(2)

at least annually following the initial diagnostic assessment, if:

(a)

additional services are needed; and

(b)

the child does not meet criteria for brief assessment;

(3)

when the child's mental health condition has changed markedly since the child's most recent diagnostic assessment; or

(4)

when the child's current mental health condition does not meet criteria of the child's current diagnosis.

D.

For an adult, a new standard diagnostic assessment or extended diagnostic assessment must be completed:

(1)

when the adult does not meet the criteria for a brief diagnostic assessment or an adult diagnostic assessment update;

(2)

at least every three years following the initial diagnostic assessment for an adult who receives mental health services;

(3)

when the adult's mental health condition has changed markedly since the adult's most recent diagnostic assessment; or

(4)

when the adult's current mental health condition does not meet criteria of the current diagnosis.

E.

An adult diagnostic assessment update must be completed at least annually unless a new standard or extended diagnostic assessment is performed. An adult diagnostic assessment update must include an update of the most recent standard or extended diagnostic assessment and any recent adult diagnostic assessment updates that have occurred since the last standard or extended diagnostic assessment.

Subp. 3.

Authorization for mental health services.

Mental health services under this part are subject to authorization criteria and standards published by the commissioner according to Minnesota Statutes, section 256B.0625, subdivision 25.

Subp. 4.

Clinical supervision.

A.

Clinical supervision must be based on each supervisee's written supervision plan and must:

(1)

promote professional knowledge, skills, and values development;

(2)

model ethical standards of practice;

(3)

promote cultural competency by:

(a)

developing the supervisee's knowledge of cultural norms of behavior for individual clients and generally for the clients served by the supervisee regarding the client's cultural influences, age, class, gender, sexual orientation, literacy, and mental or physical disability;

(b)

addressing how the supervisor's and supervisee's own cultures and privileges affect service delivery;

(c)

developing the supervisee's ability to assess their own cultural competence and to identify when consultation or referral of the client to another provider is needed; and

(d)

emphasizing the supervisee's commitment to maintaining cultural competence as an ongoing process;

(4)

recognize that the client's family has knowledge about the client and will continue to play a role in the client's life and encourage participation among the client, client's family, and providers as treatment is planned and implemented; and

(5)

monitor, evaluate, and document the supervisee's performance of assessment, treatment planning, and service delivery.

B.

Clinical supervision must be conducted by a qualified supervisor using individual or group supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of part 9505.0370, subpart 19.

(1)

Individual supervision means one or more designated clinical supervisors and one supervisee.

(2)

Group supervision means one clinical supervisor and two to six supervisees in face-to-face supervision.

C.

The supervision plan must be developed by the supervisor and the supervisee. The plan must be reviewed and updated at least annually. For new staff the plan must be completed and implemented within 30 days of the new staff person's employment. The supervision plan must include:

(1)

the name and qualifications of the supervisee and the name of the agency in which the supervisee is being supervised;

(2)

the name, licensure, and qualifications of the supervisor;

(3)

the number of hours of individual and group supervision to be completed by the supervisee including whether supervision will be in person or by some other method approved by the commissioner;

(4)

the policy and method that the supervisee must use to contact the clinical supervisor during service provision to a supervisee;

(5)

procedures that the supervisee must use to respond to client emergencies; and

(6)

authorized scope of practices, including:

(a)

description of the supervisee's service responsibilities;

(b)

description of client population; and

(c)

treatment methods and modalities.

D.

Clinical supervision must be recorded in the supervisee's supervision record. The documentation must include:

(1)

date and duration of supervision;

(2)

identification of supervision type as individual or group supervision;

(3)

name of the clinical supervisor;

(4)

subsequent actions that the supervisee must take; and

(5)

date and signature of the clinical supervisor.

E.

Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the client record after supervision occurs.

Subp. 5.

Qualified providers.

Medical assistance covers mental health services according to part 9505.0372 when the services are provided by mental health professionals or mental health practitioners qualified under this subpart.

A.

A mental health professional must be qualified in one of the following ways:

(1)

in clinical social work, a person must be licensed as an independent clinical social worker by the Minnesota Board of Social Work under Minnesota Statutes, chapter 148D until August 1, 2011, and thereafter under Minnesota Statutes, chapter 148E;

(2)

in psychology, a person licensed by the Minnesota Board of Psychology under Minnesota Statutes, sections 148.88 to 148.98, who has stated to the board competencies in the diagnosis and treatment of mental illness;

(3)

in psychiatry, a physician licensed under Minnesota Statutes, chapter 147, who is certified by the American Board of Psychiatry and Neurology or is eligible for board certification;

(4)

in marriage and family therapy, a person licensed as a marriage and family therapist by the Minnesota Board of Marriage and Family Therapy under Minnesota Statutes, sections 148B.29 to 148B.39, and defined in parts 5300.0100 to 5300.0350;

(5)

in professional counseling, a person licensed as a professional clinical counselor by the Minnesota Board of Behavioral Health and Therapy under Minnesota Statutes, section 148B.5301;

(6)

a tribally approved mental health care professional, who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), and who is serving a federally recognized Indian tribe; or

(7)

in psychiatric nursing, a registered nurse who is licensed under Minnesota Statutes, sections 148.171 to 148.285, and meets one of the following criteria:

(a)

is certified as a clinical nurse specialist;

(b)

for children, is certified as a nurse practitioner in child or adolescent or family psychiatric and mental health nursing by a national nurse certification organization; or

(c)

for adults, is certified as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization.

B.

A mental health practitioner for a child client must have training working with children. A mental health practitioner for an adult client must have training working with adults. A mental health practitioner must be qualified in at least one of the following ways:

(1)

holds a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university; and

(a)

has at least 2,000 hours of supervised experience in the delivery of mental health services to clients with mental illness; or

(b)

is fluent in the non-English language of the cultural group to which at least 50 percent of the practitioner's clients belong, completes 40 hours of training in the delivery of services to clients with mental illness, and receives clinical supervision from a mental health professional at least once a week until the requirements of 2,000 hours of supervised experience are met;

(2)

has at least 6,000 hours of supervised experience in the delivery of mental health services to clients with mental illness. Hours worked as a mental health behavioral aide I or II under Minnesota Statutes, section 256B.0943, subdivision 7, may be included in the 6,000 hours of experience for child clients;

(3)

is a graduate student in one of the mental health professional disciplines defined in item A and is formally assigned by an accredited college or university to an agency or facility for clinical training;

(4)

holds a master's or other graduate degree in one of the mental health professional disciplines defined in item A from an accredited college or university; or

(5)

is an individual who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), who is serving a federally recognized Indian tribe.

C.

Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy performed by a mental health practitioner working as a clinical trainee when:

(1)

the mental health practitioner is:

(a)

complying with requirements for licensure or board certification as a mental health professional, as defined in item A, including supervised practice in the delivery of mental health services for the treatment of mental illness; or

(b)

a student in a bona fide field placement or internship under a program leading to completion of the requirements for licensure as a mental health professional defined in item A; and

(2)

the mental health practitioner's clinical supervision experience is helping the practitioner gain knowledge and skills necessary to practice effectively and independently. This may include supervision of:

(a)

direct practice;

(b)

treatment team collaboration;

(c)

continued professional learning; and

(d)

job management.

D.

A clinical supervisor must:

(1)

be a mental health professional licensed as specified in item A;

(2)

hold a license without restrictions that has been in good standing for at least one year while having performed at least 1,000 hours of clinical practice;

(3)

be approved, certified, or in some other manner recognized as a qualified clinical supervisor by the person's professional licensing board, when this is a board requirement;

(4)

be competent as demonstrated by experience and graduate-level training in the area of practice and the activities being supervised;

(5)

not be the supervisee's blood or legal relative or cohabitant, or someone who has acted as the supervisee's therapist within the past two years;

(6)

have experience and skills that are informed by advanced training, years of experience, and mastery of a range of competencies that demonstrate the following:

(a)

capacity to provide services that incorporate best practice;

(b)

ability to recognize and evaluate competencies in supervisees;

(c)

ability to review assessments and treatment plans for accuracy and appropriateness;

(d)

ability to give clear direction to mental health staff related to alternative strategies when a client is struggling with moving towards recovery; and

(e)

ability to coach, teach, and practice skills with supervisees;

(7)

accept full professional liability for a supervisee's direction of a client's mental health services;

(8)

instruct a supervisee in the supervisee's work, and oversee the quality and outcome of the supervisee's work with clients;

(9)

review, approve, and sign the diagnostic assessment, individual treatment plans, and treatment plan reviews of clients treated by a supervisee;

(10)

review and approve the progress notes of clients treated by the supervisee according to the supervisee's supervision plan;

(11)

apply evidence-based practices and research-informed models to treat clients;

(12)

be employed by or under contract with the same agency as the supervisee;

(13)

develop a clinical supervision plan for each supervisee;

(14)

ensure that each supervisee receives the guidance and support needed to provide treatment services in areas where the supervisee practices;

(15)

establish an evaluation process that identifies the performance and competence of each supervisee; and

(16)

document clinical supervision of each supervisee and securely maintain the documentation record.

Subp. 6.

Release of information.

Providers who receive a request for client information and providers who request client information must:

A.

comply with data practices and medical records standards in Minnesota Statutes, chapter 13, and Code of Federal Regulations, title 45, part 164; and

B.

subject to the limitations in item A, promptly provide client information, including a written diagnostic assessment, to other providers who are treating the client to ensure that the client will get services without undue delay.

Subp. 7.

Individual treatment plan.

Except as provided in subpart 2, item A, subitem (1), a medical assistance payment is available only for services provided in accordance with the client's written individual treatment plan (ITP). The client must be involved in the development, review, and revision of the client's ITP. For all mental health services, except as provided in subpart 2, item A, subitem (1), and medication management, the ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP. In the case of a child, the child's parent, primary caregiver, or other person authorized by statute to consent to mental health services for the child shall be asked to sign the child's ITP and revisions of the ITP. If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal. A client's individual treatment plan must be:

A.

based on the client's current diagnostic assessment;

B.

developed by identifying the client's service needs and considering relevant cultural influences to identify planned interventions that contain specific treatment goals and measurable objectives for the client; and

C.

reviewed at least once every 90 days, and revised as necessary. Revisions to the initial individual treatment plan do not require a new diagnostic assessment unless the client's mental health status has changed markedly as provided in subpart 2.

Subp. 8.

Documentation.

To obtain medical assistance payment for an outpatient mental health service, a mental health professional or a mental health practitioner must promptly document:

A.

in the client's mental health record:

(1)

each occurrence of service to the client including the date, type of service, start and stop time, scope of the mental health service, name and title of the person who gave the service, and date of documentation; and

(2)

all diagnostic assessments and other assessments, psychological test results, treatment plans, and treatment plan reviews;

B.

the provider's contact with persons interested in the client such as representatives of the courts, corrections systems, or schools, or the client's other mental health providers, case manager, family, primary caregiver, legal representative, including the name and date of the contact or, if applicable, the reason the client's family, primary caregiver, or legal representative was not contacted; and

C.

dates that treatment begins and ends and reason for the discontinuation of the mental health service.

Subp. 9.

Service coordination.

The provider must coordinate client services as authorized by the client as follows:

A.

When a recipient receives mental health services from more than one mental health provider, each provider must coordinate mental health services they provide to the client with other mental health service providers to ensure services are provided in the most efficient manner to achieve maximum benefit for the client.

B.

The mental health provider must coordinate mental health care with the client's physical health provider.

Subp. 10.

Telemedicine services.

Mental health services in part 9505.0372 covered as direct face-to-face services may be provided via two-way interactive video if it is medically appropriate to the client's condition and needs. The interactive video equipment and connection must comply with Medicare standards that are in effect at the time of service. The commissioner may specify parameters within which mental health services can be provided via telemedicine.

Statutory Authority:

MS s 245.484; 256B.04

History:

35 SR 1967

Published Electronically:

July 5, 2011

700 State Office Building, 100 Rev. Dr. Martin Luther King Jr. Blvd., St. Paul, MN 55155 ♦ Phone: (651) 296-2868 ♦ TTY: 1-800-627-3529 ♦ Fax: (651) 296-0569