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Question: How does the family, guardian or legal representative* become aware of this option?
Answer: DHS encourages the counties and initiative tribes to find ways to circulate information regarding this service to all children and families, particularly those from underserved communities. DHS suggests a few ideas to consider: mention the service to local schools, churches, community centers, and mental health professionals; reach out and partner with families and providers from underserved communities to promote the service.
* The term “family” will be used throughout the remainder of the document to represent all these groups
Question: Is the Children’s Residential Service Path available to all Minnesota children, including those who experience health disparities and are from underserved communities?
Answer: Yes. A finite amount of money has been allocated to the 87 counties and 3 Initiative tribes. People from underserved communities are often reticent to become involved with the counties or initiative tribes. Many fear child protection will become involved if a child enters a children’s mental health residential facility through a child welfare/voluntary placement agreement with the involvement of a county or initiative tribe. This service is designed to help families get the help and support they need and want by reducing the amount of county or initiative tribe involvement.
Question: Under what circumstance would a family not be able to choose the Residential Services Path?
Answer: A family cannot access the CMH Residential Services Path if the child has already gone through a juvenile treatment screening process for the purposes of a child welfare voluntary placement agreement, child protection, or corrections and is currently in an out of home placement.
Question: Is the CMH Residential Services Path part of the Families First Preservation Services Act (FFPSA)?
Answer: No. FFPSA does not apply when a family chooses the CMH Residential Services Path. FFPSA and the CMH Residential Services Path are two very different and distinct services. When accessing services through the CMH Residential Services Path, the county and initiative tribes do not have placement authority and the Juvenile Treatment Screening Team does not convene. For more information about Family First, visit the department's Family First Prevention Services Act webpage
Question: How does this method assure equity for families and how does it effectively address disproportionality? A family residing in a county with limited funds may only be provided funds for a short period of time as compared to a family in a larger county where funds can serve more children for a longer period. Also, how does this meet the best interests of children? With no consistency in funding there is question of the quality of the care and ability to have effective discharge planning if funding only covers a short stay in placement. It may compromise the integrity of the quality of services for children who need to use public funds as compared to those who have private insurance coverage. Again, this contradicts the intent to increase equity in access to services.
Answer: Limited funding was given for CMH. The allocations were based on data from 2018-2021 for utilization of Children's Residential Facilities (CRF) to encourage equity. CMH Residential Services Path funds are intended for those publicly funded, not private insurance.
Question: What role does the family play when they would like their son or daughter to use the CMH Residential Service Path?
Answer: In order for a child to use the CMH Residential Service Path, a mental health professional (MHP) must meet with the child and complete a Diagnostic Assessment (DA). The DA must be done within the previous 180 days, indicate the child has an severe emotional disturbance (SED) and contain a recommendation indicating the MHP believes it is medically necessary for the child to enter a CMH Residential Service, a licensed residential treatment center (RTC).
The family will take the DA to the initiative tribe, if the child is enrolled, or county of residence. The family will inform the initiative tribe or county that they would like their child to enter a licensed RTC with the CMH Residential Services Path allocation as the funding source. The family will choose the licensed RTC setting and the level of county involvement. The family has the option to request a Children’s Mental Health case manager. The family is active in all planning in the residential treatment center (RTC), steering the process.
Question: How does the family become involved with the Diagnostic Assessment (DA)/Level of Care determination?
Answer: Communication between the Mental Health Professional (MHP) and the family is very important. The family must be very clear and transparent with the MHP, openly describing the child’s condition as well the family’s concerns and desires. The family should note behavioral and emotional conditions in the home, school, and community. The family should inform the MHP if they believe the CMH Residential Services Path is the best option to meet their child’s needs. Providing releases of information will help the MHP get a complete picture of the child’s history and functioning.
Question: What if the MHP does not do a Child and Adolescent Service Intensity Instrument (CASII) or Early Childhood Service Intensity Instrument (ECSII)?
Answer: The MHP is required to complete the CASII or ECSII. The CASII or ECSII indicates the MHP’s assessment of the child’s condition and assigns the level of care a child needs. If the CASII or ECSII is not provided, the MHP must document the youth is in need of the CMH Residential Service in a RTC in the recommendations section of the DA. The county will review the DA as provided in order to decide if the allocation can be distributed.
Question: Isn’t the juvenile treatment screening team meeting the Level of Care Screening?
Answer: No, the DA/CASII is the level of care determination, not the juvenile treatment screening.
Question: After the family brings the DA to the county or initiative tribe, should the entities contact the non-initiative tribe if a child is enrolled? Should they contact the MCO if a child is within the MCO network?
Answer: The county must submit a Minnesota Indian Family Preservation Act (MIFPA) notice if an American Indian/Alaskan Native child has been referred to the agency for voluntary MH TCM case management services. The DHS ICWA page provides guidance about the MIFPA process.
The MCO will pay for the child’s mental health services within the CRF. If the child is enrolled with a MCO network, the MCO is responsible for payment of mental health services. The county must inform the MCO’s when the child will be receiving the service in order for the MCO to make the payments.
Question: Does the county provide any service and support for the family?
Answer: The counties and the initiative tribes are responsible for distributing the CMH Residential Services Path allocation dependent upon availability and choices of the families. Further county or initiative tribe involvement will be determined by the family.
Question: When can a family request a case manager from the county?
Answer: The family can ask for a county or initiative tribe children’s mental health case manager at any time. If a family requests a case manager to support the child and family for discharge planning, the case manager will assist the family in locating formal and community services that help the child achieve a successful return home. The discharge plan will remain family driven.
If the child has a case manager at the time the family chooses the CMH Residential Services Path, the case manager will continue to perform the case management activities of assessment, planning, linking/referring, and monitoring/coordinating. The case manager will assist and support the family in locating the CRF. The agency can bill medical assistance for TCM as long as the case manager is performing case management activities.
*Equity and person lens: The family may identify individuals within their community that are of particular support. The case manager must listen to and support what is “important to” the family rather than deciding what is “important for” the family. The family is the expert in knowing the resources that will assist the child’s successfully return to their home community.
Question: If the child is not in a “placement” and the parents have arranged for their child’s treatment in a facility, does the county contact the tribe?
Answer: If the county agency is not providing services outside of the CMH Residential Services Path, ICWA/MIFPA do not apply.
One option is for a county social service agency to accept placement responsibility through a voluntary placement agreement (Minnesota Statutes, section 260C.227 or Chapter 260D). If the facility a child is placed in is a certified qualified residential treatment program (QRTP) then all of the Family First requirements including the juvenile treatment screening team, QRTP assessment and court oversight apply. Because the child was placed in a facility prior to the agency having legal and financial placement responsibility, the juvenile treatment screening team and QRTP assessment must be completed within 30 days of the agency signing a voluntary placement agreement.
Another option is for a county social service agency to explain to a parent prior to child accessing CMH Residential Services Path funding, that the parent is financially responsible for all residential treatment costs that exceed the state fund allocation. The county provides information to parents about the option to apply for TEFRA to access MA benefit.
Question: Is the “placement” started the date the parents/guardian sign the voluntary placement agreement (VPA)?*Note: CRFs are considered foster care settings.
Question: Not all children are IV-E eligible. When there is not a “placement,” under what authority may the agency require information from the family needed to determine IV-E eligibility?Question: How is DHS defining a children’s mental health residential service?
Answer: The CMH residential service is a licensed Residential Treatment Center (RTC). Guidance can be found on the DHS Children’s Residential Facilities webpage.
Question: Can a RTC deny the provision of this service?
Answer: It is permissible for a RTC to use this payment source when providing the service for the child. The agency and the CRF should discuss how they will work together to ensure the children from the agency receive the service using the allocation. This may require a special contract. DHS will not be prescriptive in how the agencies arrive at a service arrangement.
It is important to note that licensed CRFs may deny admission for other reasons. The child may have behavioral or mental health concerns or the licensed CRF may not have beds available at the time of referral.
Question: What is the direction if agencies facilities require guaranteed payment by the agency and a VPA for placements covered under this option. Is this being addressed with CRF’s? If so, what direction is being given to the facilities?
Answer: No communication has been given to facilities by DHS. DHS defers this responsibility to the agency because the agency is making the CMH Residential Services Path payment to the facility. It is important to remember this is a service, not a placement.
Question: Does the agency have the ability to direct the family about which CRF they must use?
Answer: If the family requests assistance in locating a service, the agency will assist them. The agency will not direct the family. The family chooses the licensed CRF they would like to use.
Question: How will the licensed CRF help and support the family in planning for the discharge from the CRF?
Answer: The CRF will begin planning for discharge within the first 30 days after the child enters the setting. The family will drive the treatment plan and the discharge plan. The family will determine the level of support and services that fit their needs upon discharge. Services and support can include involving informal supports such as relatives, community members, and formal supports such as the school, therapists, and case managers. The licensed CRF should use a person centered lens, not deciding what and who are ‘important for’ the family but letting the family decide what and who are ‘important to” them. The family and child are the experts. The licensed CRF should ask the family to consider and select individuals they feel are safe and supportive. The licensed CRF will schedule a meeting to review the child’s treatment every 60 days.
Question: Can we clarify the position on this related to Interstate compact on the placement of children (ICPC)?
Answer: ICPC applies to anytime a child enters residential/facility placement in another state. The county may have placement authority through a court order or VPA; however, the ICPC also applies when a parent privately utilizes a CRF when the agency is not involved and a court order has not been obtained.
A receiving state must consider a Minnesota child the subject of an ICPC in all the circumstances. If the parent uses private insurance when their child enters an out of state CRF the CMH Residential Services Path allocation cannot be used. The CMH Residential Services Path funds may be used if the child is on MA.
The facility completes paperwork with the parent or legal guardian. The facility will submit the required ICPC documents to DHS.
Question: If the local social service agency agrees to provide funding for the service but is not providing oversight or case management services, does the local social service agency maintain liability for the quality of care and services provided through the contracted treatment facility?Question: What happens when a child is within a Managed Care Organization (MCO) network or has private insurance?
Answer: The allocation is intended for those publically funded, not for private insurance. DHS has made this policy decision. If the child has Medical Assistance (MA), MA pays for the mental health services. If the child is enrolled in a MCO network, the MCO pays mental health services. The agency will continue to pay room and board as long as the allocation is available.
Question: How does the county or initiative tribe confirm funds are available? Is it based on the appropriation of funds for CMH Residential Services from DHS and what was budgeted by the county or initiative tribe?
Answer: The state will not provide oversight over the system the agency develops or uses to track the allocation utilization. The county or initiative tribe will make budget decisions independent of DHS.
Question: What is the agency’s role in ensuring the families are aware of the availability of CMH Residential Services Path funds?
Answer: After the agency assesses the availability of allocated funds, they will inform the family of their ability to pay for the service and how many days they are able to pay for. If funds are available before the family and/or agency attempts to locate a CRF. If there is a delay in locating a CRF and funds are no longer available. The agency the agency must inform the family of the change in status.
Question: In instances where a child under the age of 18 enters a CRF through the CMH Residential Services Path and then turns 18 while in care, will the Adult Behavioral Health fund continue to reimburse for the service?
Answer: The county or initiative tribe will which funding source they would like to use when the individual is an adult.
Question: If the county or initiative tribe does not agree with the MHP’s recommendation for the child to enter the setting or would rather use the allocation with other children they believe to be in greater need, does the county or initiative tribe have the right deny the service?
Answer: No, the agency does not have the right to deny the family and child access to this service if the agency county has monies available from their allocation.
Question: Does the CMH Residential Services Pathway apply to children who are already in a licensed CRF with payments from private insurance? What if the private insurance denies the placement because: (a) the private insurance benefit is exhausted or (b) the private insurance indicates the placement does not meet criteria?
Answer: No. When the insurance benefit has exhausted or will not provide the payment, the family can bring a DA to the agency. The MHP must indicate the child has a SED. The MHP must recommend the child should enter a CRF. If the child is eligible for MA and funding is available, the family is eligible for this service.
Question: Is the agency responsible for payment of the service after the allocation runs out?
Answer: The agency is not responsible for paying beyond their allocation. Agencies are encouraged to speak with their legal counsel about this matter. The agency is responsible for informing the family that parental fees may be assessed. The entities should make this notification at the onset. This will assist the family in making an informed decision in the event the county’s allocation runs out while the child is in the setting. If the family would like to have the child remain in the setting, a county or initiative tribe case manager will be assigned. If the family would like to apply for TEFRA (Tax Equity and Fiscal Responsibility Act), the case manager should assist the family if assistance is requested. The family will be asked to sign a VPA. FFPSA requirements and process, including the juvenile treatment screening team process and review in juvenile court, would apply.
Question: How was the allocation determined?
Answer: The CMH Residential Path allocation is finite. The allocations were determined through assessing the 87 counties and 3 Initiative Tribes licensed CRF utilization data. The funding allocation formula was determined by using the number of children admitted to CRF from 2018-2020, totaled for each county and tribe then divided by the total grant fiscal year allocation to get an average cost per child. The average cost per child was then multiplied by the average number of children per county or tribe admitted to Children’s Residential Facilities (CRF) over the 3-year period.
Question: Does the allocation pay for 100% of the room and board? Or is the county responsible for any portion of the room and board, since CMH Residential Services Path was intended to offset the IV-E funds and IV-E pays for a portion of the room and board, this would then leave about 25% still needing to be paid for?
Answer: Yes, CMH Residential Services Path allocations are intended to pay for 100% of the room and board.
Question: Typically, IV-E covers up to 50% of room and board costs. Who is responsible for the portion of the costs which would not be IV-E eligible? It was the understanding counties were not to bear the fiscal responsibility in provision of this service.
Answer: This is a question to be discussed between legislative author, National Alliance of Mental Illness (NAMI), agencies, and DHS. If funding gaps are identified, the agencies and DHS will may collaboratively work with NAMI to draft legislation requesting additional funds.
Question: The FAQ states families may be charged a fee. However, this is not considered a placement but a new “service.” What fee process is being referenced?
Answer: Fees may be assessed if the agency chooses to develop a fee for the CMH Residential Path service. The state does not cover the costs beyond the allocation. Agencies may develop practices that will assist families in making informed decisions as they consider applying for TEFRA avoid the risk of disruption of their child’s care.
Question: Is there a statutory basis for counties to deny the service once the county allocation is exhausted?
Answer: Agencies are not required to continue to pay for CMH Residential Services Path services beyond their allocation. Minn. Stat. 245.4882. The CMH statute does not require agencies fund services beyond the appropriated funding Minn. Stat. 245.486. The CMH Residential Services appropriations are limited. Laws of Minnesota, 1st Special Session, Chapter 7, Article 16, section 2, subdivision 32.
Question: What is the appeal process for families if a county’s allocation has been exhausted? Would this appeal be of the county or DHS?
Answer: No. CMH Residential Services Path is not part of the Children’s Mental Health Act. Therefore, the parent does not have the right to appeal the denial of services under 245.4887. If the local agency has an appeal process specific to that agency, the county or initiative tribe may choose to consult with their legal counsel.
Question: What statutes direct the CMH Residential Services Path?
Answer:
Question: Can a county or initiative tribe decline the CMH Residential Services Path allocation?
Answer: It is permissible for the agency to decline the CMH Residential Services Path allocation. Agencies are encouraged to consider how the CMH Residential Services Path will address disparities in underserved communities when making this decision.
Allocations are distributed on a fiscal year basis. The SFY2022 and SFY2023 allocation amounts can be found on County Link under the “Fiscal Reporting and Accounting” tab and are distributed as a one-time lump sum payment for both fiscal years together. The SFY2022 dollar amount can be used in SFY2023. The allocations that some counties chose to decline by May 27, 2022 have been redistributed to the counties willing to accept the allocation based on the original formula used.
Allocations were distributed the week of October 17, 2022.
Question: What happens if a county or initiative tribe has underspending?
Answer: Counties and initiative tribes will report their expenditures during FY23. If any portion of the allocation goes unused for the fiscal year, DHS will invoice the counties or initiative tribes at the end of the allocation, June 30, 2023. DHS will compare expenditures reported with the allocation allotted, and send an invoice for the difference.
Question: When a CRF bills the county, how would the county be paid for the fee for service/state share of the treatment cost when a child is MA FFS? How is the State's share of the treatment costs being paid to the "agency"?
Answer: When a child has FFS Medical Assistance (MA) coverage, MA covers treatment costs when a child accesses CRF through the CMH Residential Services Path. The county pays full treatment costs to the CRF and submits for reimbursement through the health care claiming process for a portion of the nonfederal share of the treatment costs.
Payments to counties for residential services provided by an institution for mental diseases (IMD) is equivalent to the federal share of the payment that would have been made if the residential facility were not an IMD. The portion of the payment representing what would be the nonfederal share shall be paid by the county (Minn. Stat. §256B.0945, subd. 4, paragraph 2).
Question: When a child on regular MA enters an IMD facility but there is no placement entered, how will the county get reimbursed for paying the facility for the treatment costs?
Answer: If an agency chooses to not affiliate the client with a CMH workgroup within SSIS, services can still be paid in SSIS. Payments do not need to be associated with a workgroup, but should be associated with a client. If the client does not already exist in SSIS, an intake workgroup could be created (e.g., Type- Information and Referral, Problem- Mental Health, Program- Children’s Mental Health). By performing this step, a client record would be created allowing for client specific payments and billing. The intake can be screened out if no workgroup will be opened by the county. Further questions can be directed to the SSIS Help Desk at dhs.ssishelp@state.mn.us.
Question: Per the bulletin #22-53-02 published on March 11, 2022, “payments can be created in SSIS on behalf of the client if the agency is financially responsible for the client. If an agency chooses to not affiliate the client with a CMH workgroup within SSIS, services can still be paid in SSIS. A workgroup is not required on the payment.” Historically, services paid through SSIS must have an associated workgroup. What is the process for this? What is the mechanism to track payments if not associated with a client?
Answer: Payments do not need to be associated with a workgroup, but should be associated with a client. If the client does not already exist in SSIS, an intake workgroup could be created (e.g., Type- Information and Referral, Problem- Mental Health, Program- Children’s Mental Health). By performing this step, a client record would be created allowing for client specific payments and billing. The intake can be screened out if no workgroup will be opened by the county. Further questions can be directed to the SSIS Help Desk.
