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Services Guide




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What's in this Guide?

This guide and all chapers contain policies and procedures for all of the services we provide, and activities related to service provision. This first chapter includes a lot of information about services, fees, payments, etc.

What is noteworthy about this guide is what we do not know. We are constantly encountering new situations that raise new questions. We can use your help with this. Send feedback at the link at the bottom of this guide and check back often.

As we learn of changes in the rules, and as we learn from you and the people we serve how we can improve the services we provide and the content of this guide we'll update it.

Blue text  are links to more information from external sources (opens in an new tab), or elsewhere in the guide (navigates there - hit the back button on your browser if the link is not what you needed).   

Health-Care Coverage for Services

Minnesota Health Care Programs (MHCP)

The vast majority (95%+) of our clients receive services from us via MCHP programs. Private/commercial insurance programs rarely pay for services other than Psychotherapy.

Individuals with low income and disabilities qualify for MHCP coverage in a variety of ways. There are income and asset limits that vary depending on how they qualify.

MHCP includes Medical Assistance, quite often managed by a Managed Care Organization, especially for the elderly and persons with disabilities, and MinnesotaCare, an income-based program that includes premiums on a sliding fee scale for individuals with lower incomes regardless of disability.

Types of MA
MinnesotaCare

MinnesotaCare is a premium-based program available to citizens of Minnesota with low incomes who do not have access to Medicare, Medical Assistance, or employer-sponsored coverage. Members pay a monthly premium for MinnesotaCare based on family income. It is funded by premiums on a sliding fee scale with state assistance.

Private/Commercial Insurance

We accept private or commercial insurance when the policy covers services. Referrals or requests from individuals for services from us are rare, but not unheard of. At this time, no private/commercial insurance programs of which we are aware pay for any of the services we provide other than Psychotherapy and Diagnostic Assessments.

Medicare

Medicare is a federal program that covers healthcare services to individuals typically over 65. Coverage for the services we provide is limited - typically Medicare covers only Psychotherapy and Diagnostic Assessment. It never pays for: ARMHS, Mental HealthTargeted Case Management, Behavioral Health Home Services, or Housing Stablization. Clients who need these services must have Medical Assitance - which they can have in addition to Medicare.

Check Insurance Before Initiating Services

Contact the billing department to confirm  insurance coverage before initiating new services, even for existing clients. Not all of the services we provide, for example, are covered by MinnesotaCare (e.g. MinnesotaCare does not cover Behavioral Health Home Services and Housing Stabilization Services).

Client Responsibility for Payment

In a variety of circumstances, clients are responsible for payments for services. These might include:

Spenddowns

Editor's Comment on Spendowns

Spenddowns are perhaps one of the most unjust elements of our MA system. How they work in most cases is that recipients of MA, who have worked in the past and are now disabled, and as a result have social security disability income above poverty guidlines, must spend down to pay for MA to the level of poverty.

No sliding fee scale exists for spenddowns or provisions to allow individuals who worked and paid into social security to retain even a portion of this hard-earned benefit when they become disabled.

This is wrong and we should lobby to change it.

A spenddown is a monthly amount a recipient of Medical Assistance must pay for healthcare services when the client's household income exceeds 100% of the federal poverty guideline. MA recipients may choose two options for spenddowns:

  1. Recipients may pay their spenddown directly to DHS the month prior to the spenddown month. Arrange this using DHS 3081.
  2. Recipients with PCA or Waiver services may choose this provider as the designated provider to whom they will pay their spenddown using the form DHS 3161.

For recipients who do not choose or are not eligible for either option bove, the spenddown will be deducted from the first service provider who bills for services in a given month. If this spenddown is deducted from services we provide, we will bill the client for the spenddown.

Spenddowns Required.

Recipients of MA on the basis of disabillity with a spenddown are required to pay it to maintain MA Eligibility. Except in certain conditions, providers cannot routinely waive member cost sharing without violating the federal Anti-Kickback* law and the federal False Claims Act. No matter how we feel about the fairness of spenddowns, we are required to bill individuals who incur them for services we provide and have policies for non-payment.

*A kickback is any financial incentive a healthcare provider offers to entice an individual to get services from them.

One Possible Option to a Spenddown: MA-EPD

Medical Assistance has a program called MA-EPD (Medical Assitance for Employed Persons with Disabilities. If individuals with high spenddowns are able to find employment that pays at least $65.00/month, they may qualify for this benefit.

Recipients pay a monthly premium for MA-EPD. Premiums are based on income and household size. The amount is set by a sliding-fee scale or a minimum of $35, whichever is greater. To get an estimate of premiums, use the MA-EPD calculator found here at DB101.

Unearned Income Obligation for MA-EPD

If recipients have unearned income like Social Security Disability, they must pay one-half of one percent of unearned income each month. To calculate the unearned income obligation, multiply your total unearned income by .005. This cost is in addition to the monthly premium.

Copays for MA-EPD

Recipients may also have copays for non-preventative healthcasre services. There are not copays for mental health services in any Medical Assistance program in Minnesota.

Renewing MHCP Coverage

All recipients of MHCP insurance must renew their coverage annually. Typically, they will receive notice of renewal about two months before the month they originally applied for health insurance.

For some individuals, DHS can automatically renew MA or MinnesotaCare for everyone in the household. They will send a notice and an information summary. Recipients must review the information summary to make sure all the information about them and their family is correct. They don't have to do anything else, unless they have a change or correction to report.

When DHS cannot automatically renew MA or MinnesotaCare for one or more people in a household, DHS will send a renewal form to complete, sign and return. Recipients must return the form by the due date. When DHS gets the completed renewal form, they will decide whether the people in the household remain eligible for health care coverage.

Important Actions for Providers

Essential for all providers is monitoring renewal dates and helping clients with renewals. the View Insurance Status Alerts report, available on the home page of TabsTM tells you when renewals are coming due. Monitor this report and understand the following:

*The Insurance Alerts report is current being reworked to match color protocols in Due Items. Check back soon for more details.

Do not assume that clients will respond in a timely manner and correctly. Offer assistance with this task as it can be complicated.

Document your assistance with renewing healthcare coverage using the note type Insurance Advocacy or the add-on Insurance Advocacy During/After Service.

Retroactive Coverage

For all recipients of MA where insurance has lapsed, they may apply for retroactive coverage up to 3 months prior to renewal if they have received health care services, including services from Accend, that were not paid due to a lapse in insurance.

Procedures for Non-Payment

This section describes how clients will be notified and billed for services provided when they have responsibility for payment. These include:

Intake Treatment Consent

The initial Treatment Consent (included in the Treatment Plan) identifies charges that may be billable to the client. During the intake process, you will receive information from billing on potential charges to the client and must inform them during the intake process.

Changes in Client Responsibility

Changes in client responsiblity for payment may be identified upon renewal. In this case, you (the provider) and they (client) will be notified of new client responsibility for payment by the billing department. In this case, a new Treatment Consent is required, notifying the client of new charges for services they will receive. Use the stand-alone Treatment Consent form to inform the client of new charges to them.

This must be done immediately upon discovery of new charge:  clients must be informed of new charges and offered the opportunity to decline services if they do not wish to receive the services and pay the associated fees.

Co-Pays and Deductibles

There is no cost-sharing (copays or deductibles) for individuals on Medical Assistance, including PMAP/MCO coverage.

Theres is no cost-sharing (copays or deductibles)for Mental Health services for individuals with MinnesotaCare. Non-mental health services we provide (BHH, HSS) are not covered by MinnesotaCare.

Clients with commercial insurance will in almost all cases have co-pays, deductibles, or both.

Clients with MA=EPD may have copays for some non-mental health healthcare services.

Spenddowns

When we receive notice that a client has a new spenddown or when a client a past-due balance, provider staff will be notified using the form Notification of New, Changed or Past-Due Spenddown. Please review Spendowns and options above and be prepared to compassionately work with the client and educate them about their options.

Procedures

Non-payments of charges to clients shall be handled as follows:

Payment Plans

We may develop payment plans for clients with overdue payments. These can be as little as $5.00 per month over and above current charges for which they are responsible.

Returning Clients with Bad Debt

Clients who have terminated services and return requesting more may have bad debt from a previous episode of care. For these individuals, a payment plan must be started upon re-initiation of services using the form Notification of New, Changed or Past-Due Spenddown.

Service Rates

Rates paid for services provided vary based on the payer. The rates in the table below reflect the rates we bill for each service we provide and the amounts we are paid. Tap and scroll in the table to view entries.

Rates reimbursed vary based on payer, some payers pay less for some services. Rarely do they pay more. While we appeal denials, on average, we collect 80% of what we bill. 

Often payers reject claims resulting in no revenue for the service provided (zero pay). Denials often appear arbitrary, or may be associated with mistakes on our part or the part of the payer. We appeal these denials but may or may not ever receive payment.

Rates Tables

Please be aware that this table may contain errors where rates have changed - a common occurence - but we will try to keep this up-to-date when we learn of rate changes.

Rates Billed Vs Costs

Please keep in ming that rates billed are one thing, while costs include not just staff time, but all expenses related to service delivery, inclduding administrative staff supports, leases for properties, program costs and supplies, staff training costs, etc. These are broken down in a broad sensen in the Money Follows Mission guide.

Rates Tables

Some of the tables below are scrollable. Tap in the table and scroll up or down to see details.

ARMHS Code Type Rate Billed
FA Initial Interview or Observation H0031 Occurrence $85.86
FA Update Interview or Observation H0031-TS Occurrence $85.86
ARMHS Treatment Planning Interview H0032 Occurrence $85.86
ARMHS Group H2017-HQ 15-minute unit $7.92
ARMHS Individual H2017 15-minute unit $17.17
ARMHS Transition to Community Living H2017-U3 15-minute unit $18.02
ARMHS Community Intervention 90882 Occurrence $51.11
ARMHS Community Intervention TCL 90882-U3 Occurrence $51.11
ARMHS Peer Specialist Services Level II H0038-U5 15-minute unit $18.02
ARMHS Peer Specialist Services Level I H0038 15-minute unit $15.77

ARMHS Medication Education Code Type Rate Billed
Medication Education H0034 15-minute unit $18.02
Med Education Community Intervention 90882 Occurrence $51.11

Behavioral Health Home Services Code Type Rate Billed
x-Services Monthly Contact 252.35 - $360.50

AMH-TCM Code Type Rate Billed
x-Services Monthly Contact $446 - $500

Clinical Professional Code Type Rate Billed
Family Pscyhoeducation H2027 Unit $29.75
Standardized Outcome Measurement H0031-UA Occurrence $85.86
Interpreter Services Face-to-Face T1013 15-minute unit $12.50
Interpreter Services Telemedicine T1013 GT 15-minute unit $12.50
Interactive Complexity DA 90785 Add-on to DA $12.41 to $15.35

CTSS Code Type Rate Billed
CTSS Treatment Planning H0032-UA Occurrence $85.65
CTSS in Hospital or Facility H2014-UA 15-minute unit $13.44
CTSS Skills Training H2014-UA 15-minute unit $13.44
CTSS Skills Training Group H2014-UA-HQ 15-minute unit $9.03
CTSS Family Skills Training H2014-UA-HR 15-minute unit $17.50
CTSS Crisis Assistance H2015-UA 15-minute unit $14.33

CTSS Psychotherapy Code Type Rate Billed
CTSS Treatment Planning H0032-UA Occurrence $85.65
CTSS Crisis Assistance H2015-UA Unit $14.33
CTSS Psychotherapy 30 Minutes 90832-UA 16 - 37 minutes $84.89 - $94.88
CTSS Psychotherapy 45 Minutes 90834-UA-HN 38 - 52 minutes $111.17 - $122.95
CTSS Psychotherapy 60 Minutes 90837-UA 53 + minutes $165.16 - $181.68
Psychotherapy Crisis Child CTSS 90839-UA Occurrence $168.17 - $184.89
Psychotherapy Crisis Ext Child CTSS 90840-UA Add-on of 30 minutes $77.22
Psychotherapy MultiFam Child CTSS 90849-UA Occurrence $38.77 - &42.85
Psychotherapy Grp Child CTSS 90853-UA Unit $29.55 - $32.51
Child Clinical Care Consultation 90899 Occurrence $15.35
Interactive Complexity 90785-UA Add-on to DA or Therapy $12.41 to $15.35

Housing Stablization Services Code Type Rate Billed
xHousing Sustaining Supports Indirect H2015 15-Minute Unit $17.17
xHousing Transition Supports Direct H2015-U8 15-Minute Unit $17.17
xHousing Transition Supports Indirect T2024-U8 Occurrence $17.17
xHSS Plan Submitted Non-AMH-TCM Client $174.22

Psychotherapy Adult or Child (Non-CTSS) Code Type Rate Billed
Psychotherapy 30 minutes 90832 Occurrence $86.86
Psychotherapy 45 minutes 90834 Occurrence $86.86
Psychotherapy 53+ minutes 90837 Occurrence $128.35
Psychotherapy Family with Recipient Present 90846-HN Occurrence $85.96
Psychotherapy Family without Recipient Present 90846-HN Occurrence $82.98
Psychotherapy Crisis 90839 Occurrence $122.08
Prolonged Psychotherapy Crisis 90840-HN Add-on $61.49
Psychotherapy Group 90853 Occurrence $22.98
Psychotherapy Multi Family 90849 Occurrence $30.14
Psychotherapy Interactive Complexity 90785 Add-on $12.41 to $15.35

Mental Health Travel Code Type Rate Billed
Mental Health Travel* H0046 Minute $0.52

*Please notice that travel reimbursement is not comprehensive. Paid by the minute, it typically pays for staff time, but not the mileage costs we reimburse.


Feedback or Questions about this Guide

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.

Updates to This guide



September 27, 2024:

Major update with procedures for spenddowns, client responsiblity for payment of copays, deductibles and spenddowns. Service rates posted.



October 4, 2024:

Additional and clarified information about Spenddowns. Navigation menu enhanced. Procedures for non-payment clarified.



October 16, 2024

Additional and clarified information about Spenddowns and MA-EPD. Links to resources and forms for both added.



October 22, 2024

Missing Psychotherapy service (30 minutes) added and broken link to assets and income fixed.