Purpose
All mental health/behavioral health services begin with A Diagnostic Assessment, or DA. A DA is conducted by a licensed Mental Health Professional or Clinical Trainee and serves these core purposes:
- to identify whether or not a referred individual has a diagnosis (or diagnoses) of mental illness or a behavioral disorder;
- to identify the diagnoses and their severity;
- to preliminarily determine a referred individual's eligibility for services;
- to make recommendations for services based on the individuals diagnoses and the needs the person has identified in the DA and Intake interviews; and
- in the case of an annual DA update, one of several strategies we use to assess treatment progress and success..
DA Requirements and Deadlines
A DA is required prior to admission and annually for continuing all community-based mental health services. To establish initial and continuing sligibility, the DA must identify a mental health or behavioral disorder, and for services other than psychotherapy, determine that services are medically necessary due to impairments in functioning or risks of harm, hospitalization or residential treatment resulting from the individual's diagnosis, symptoms and/or behavior.
Find additional requirements for eligibility for each of the different services we provide in the guide section for those specific services.
A Diagnostic Assessment is complete after it all of the findings and treatment recommendations have been written and it has been approved by a Licensed Mental Health Professional.
General Guidelines for Diagnostic Asssessment
What follows are general guidelines for when we complete DAs.
| Circumstances or Services |
Guidelines |
| Generally When |
Generally, we conduct DAs to establish and maintain medical necessity for services, following the guidelines per service below.
However, we may conduct a DA even if not required under any of the following circumstances (not an inclusive list):
When an individual's behavior, status, or other life factors have changed and a new DA may shed light on new medically necessary services.
When making a referral to external services where a DA is necessary and providing a DA will help expedite the start of these services.
|
| Generally When Not |
We do not conduct DAs as requested by external providers for whom DA updats are necessary unless we Hhave reason to conduct the DA for reasons related to services we provide.
External service providers who require updates to a DA are responsible for finding their own resources for updates to the DA.
|
| Adult Mental Health Targeted Case Management |
A recent (within one year prior to the start of services) Diagnostic Assessment is required that establishes eligibility for AMH-TCM services based upon a diagnosis of SPMI.
An updated DA is required at least very three years after admission.
|
| ARMHS |
A recent (within one year prior to the start of services) Diagnostic Assessment is required that establishes eligibility for ARMHS based upon a diagnosis of SMI or SPMI.
The DA should be reviewed annually and an update conducted based on the conclusions and clnical judgment of the clinical reviewer. |
| Behavioral Health Home Services |
Only a single DA is required, recent (within one year prior to the start of services). |
| CTSS |
A recent (within one year prior to the start of services) Diagnostic Assessment is required that establishes eligibility for ARMHS based upon a diagnosis of SMI or SPMI.
The DA should be reviewed annually and an update conducted based on the conclusions and clnical judgment of the clinical reviewer. |
| Housing Stablization Services |
Only one DA is necessary, and this only if eligibility for Housing Stabilization Services is based on a mental health diagnosis. There may be other eligibility reasons, including aging, physical disability, etc. |
| Psychotherapy |
A DA is required inititally prior to the third session.
For MHCP-funded Psychotherapy services, the DA should be reviewed annually and an update conducted based on the conclusions and clnical judgment of the clinical reviewer.
For commercial and private insurance, DAs are required by the payer and may vary. Best practice is an annual review. |
Types of DAs
There were previously four basic types of Diagnostic Assessments. These were:
The Standard DA
Used most often, the standard DA consists of an interview and write-up.
The Extended DA
An extended DA is no longer an option.
The Adult DA Update
The Update DA was eliminated with MN Statute 245I in October, 2022.
The Brief DA
Used rarely, the Brief DA consists of an interview and write-up, but includes less information than a standard DA. A breif DA might be appropriate for an individual who will not likely need more than 10 total sessions of psychotherapy following the DA.
Adult Intake Diagnostic Assessment
The Adult Intake Diagnostic Assessment is a standard DA that explores functioning in more detail for use in determining potential need or eligibility for adult services such as ARMHS, Case Management or Behavioral Health Home Services. Certain componenents in the intake DA map to the Adult Intake Functional Assessment to:
- streamline the initial assessment process,
- eliminate redundancy and prevent an individual from having to tell his or her story repeatedly, and
- facilitate rapid response to the immediate needs that brought the individual to us for service.
Use the Adult Intake DA for all new adult referrals who are seeking, or may be seeking, mental health services beyond psychotherapy.
Explanation of Findings
Explanation of Findings is a service that can follow a DA that consists of meeting with a person who has received a Diagnostic Assessment, and perhaps family members or service providers, to explain the diagnosis, findings, and treatment recommendations in the DA.
Corrections or Updates to DAs
From time to time, DAs will be sent back for corrections, or addendums to the DA may be requested. This may occur when (not an all-inclusive list):
- Treatment Recommendations are unclear
- Required Medical Necessity statements, where required for some services do not meet standards required by the recommended services, are not adequate per statute, rule or MHCP guidelines
- Treating Diagnoses are not billable Diagnoses, or no treating diagnosis is identified
- Other reasons
Individuals authorized to unapprove a DA and send it back for corrections include:
- The Executive Director
- The Program Director
- The Billing Manager
- The Clinical Director
- The Clinical Supervisor of a Trainee
Addendum, Edit or New DA?
When a problem with a DA is identified, either an edit to the current DA, or an addendum will be requested. The following describes the best practices we will use for this.
Addendum
We will request an addendum when:
- New information has been obtained, services have been initiated/continued using the current DA, and changes are needed, but can be identified with an addendum rather than a new DA
- A new need for services has been identified and those services were not recommended in the existing DA, but these can be identified with an addendum rather than a new DA
- The current DA does not contain a billable diagnosis for some services, while other services have been initiated under the previous DA and this be identified with an addendum rather than a new DA
- Other
Edit to DA
We will request an edit to a DA when:
- The DA is a new update and services are currently proceeding under the previous DA, but there are problems, as described above with the new DA
- The DA is an Intake DA and services have not yet begun, but there are problems, as described above with the new DA
- Other
New DA
We will request a new DA when:
- The current (most recent) DA or external DA is inadequate in content to justify services needed (needed as determined by the judgment of the Treatment Supervisor or others)
- There has been a substantial reported change in functioning or symptoms since the most recent DA.
- Other
Learn More
Tap on the following links to learn more:
Diagnostic Assessment - MHCP Manual.
Minnesota Statute 245I.10.
This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.
April 5, 2023:
Update DA eliminated as a type of DA.
Navigation menu updated.
Jun 6, 2023:
Clarification of when a DA might be sent back for corrections, and by whom.
Navigation menu updated.
Jun 8, 2023:
THe Extended DA is no longer an option for billing DAs.
April 10, 2023:
Language added that an annual DA is no longer required for any service, rather the previous DA is reviewed and a new DA conducted if determined necessary or recommended by the conclusions in the review.
