This is the Services guide.
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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).
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.
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.
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 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.
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).
In a variety of circumstances, clients are responsible for payments for services. These might include:
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:
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.
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.
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.
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.
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.
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.
This section describes how clients will be notified and billed for services provided when they have responsibility for payment. These include:
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 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.
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.
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.
Non-payments of charges to clients shall be handled as follows:
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.
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.
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.
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.
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.
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.
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.
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.