Direct Access: Frequently Asked Questions

The parallel process allows for an individual to access treatment two different ways until July 1, 2022. The parallel process refers to the timeframe from October 1, 2020 to July 1, 2022 and allows for individuals to have two options to access SUD treatment services. Individuals can follow the previous process that has been in existence since the 1980s called the Rule 25 process, or they may reach out to an appropriately enrolled Minnesota Health Care Programs (MHCP) provider of their choice for specific services and access services directly (Direct Access).

The Rule 25 process for accessing treatment will no longer be available after July 1, 2022. The parallel process allows for the community including counties, tribes, and substance use disorder (SUD) treatment providers to ease into the new way of accessing services (Direct Access) without disrupting the ability for individuals to continue to seek treatment access services. DHS recognizes this is a significant change to how things have been done for a number of years and wants to allow time to transition and be sure that our processes and systems are in place to support those in accessing the necessary SUD services.

1. Determine coverage
   
   The first step is to determine if the client has insurance, ask the client and verify eligibility in MN–ITS . You can continue with the Direct Access process immediately if there is either Medical Assistance or OO eligibility in MN–ITS.
   
   1. For those enrolled with a Managed Care Organization (MCO), the provider should coordinate the treatment and payment with the plan. Call the MCO  for further instruction.
   2. If the client does not have eligibility indicated in MN–ITS, connect with the individual’s county/Tribe of financial responsibility to determine if they may be eligible for funding through the Behavioral Health Fund (BHF). Although the financial eligibility guidelines are the same, please coordinate with the county/Tribe to complete financial eligibility determination.
   3. If the client has Medical Assistance or OO eligibility and commercial insurance, the provider must contact the county/Tribe of residence and ask them to enter the insurance information into the Third Party Liability File. The provider must bill the insurance first and bill the rest to DHS to be paid by Behavioral Health Fund.
   4. A list of contact information for counties can be found at “Guide to Minnesota’s Public Health Care Programs.” 
      
      
2. Client choice
   
   Inform the client of their choice to continue to work with you to access services directly or to go to county/Tribal office for Rule 25 process. If you receive a client who has already completed a Rule 25 assessment, work with the county/Tribe and complete the process using the Service Agreement (SA). If the client is in treatment and their SA runs out, either contact the county/Tribe who originally placed them with you and request an extension or bill directly to DHS without a SA if the client is enrolled with medical assistance. You may need to work with county/Tribe to re-determine financial eligibility.
   
   
3. Access previous assessment
   
   If the client wants to continue to follow Direct Access process and is financially eligible, ask the client if they have had any assessments done previously, and if so, where. Have the client sign a release of information to the provider to obtain the previously completed assessment (could be Rule 25 or comprehensive assessment). Review and update the assessment to determine current severity ratings.
   
   
4. Completing an assessment
   
   Provider completes an assessment or utilizes an existing assessment and would then create a DAANES assessment record for the individual. It is the responsibility of the provider, if using a previously completed assessment, to review and update the severity ratings to determine if the level of care should remain the same as was previously indicated. Remember, the client chooses which level of service they wish to utilize that is equal to or less than that which is recommended by the severity ratings. The client may also choose the service provider. This may be with the provider who did the assessment OR with another provider of their choice. Residential providers who do a comprehensive assessment for a client that chooses to go to, or is referred to, another facility for their care may bill for the comprehensive assessment done prior to admission into a program and done as a placing tool. If the client chooses treatment at your facility and begins treatment that same day, the comprehensive assessment is NOT payable separate from the daily per diem paid for the treatment services.
   
   
5. Admit and provide service or refer to appropriate level of care.
   
   If the individual meets the appropriate severity ratings for the level of care your agency provides and chooses to attend your program, you can move forward with completing the DAANES admission record. If the client chooses or is referred to a different program, just complete the DAANES assessment record.

During the parallel process a county/tribe continues to be responsible for determining financial eligibility as stated in MN Rule 24, providing the requested Rule 25 assessments and supporting individuals in their county/tribe with accessing substance use disorder treatment services. This may be done by the county/Tribe or a contracted agency or individual enrolled with Minnesota Health Care Programs (MHCP) for that service.

Accessing services and following the Rule 25 process that has existed since the 1980s is still an option until July 1, 2022.

Counties/tribes may also choose to be enrolled with Minnesota Health Care Programs. As indicated in 254B.05 Subd. 1(c), “A county is an eligible vendor for a comprehensive assessment and assessment summary when provided by an individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 5, and completed according to the requirements of section 245G.05. A county is an eligible vendor of care coordination services when provided by an individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 7, and provided according to the requirements of section 245G.07, subdivision 1, paragraph (a), clause (5).”

Beginning now and beyond July 1, 2022, Counties have continued responsibility for determining an individual’s financial eligibility for the Behavioral Health Fund, Minnesota Administrative Rule 9530.7000 to 9530.7031. What this process looks like for each county or Tribe may also differ. Please reach out to the county/Tribe to determine what their process is for determining client’s eligibility for the Behavioral Health Fund. If it is determined the individual is eligible, it is the responsibility of the county/Tribe to do the system work necessary to allow a provider to be able to verify eligibility in MN–ITS and see major program OO or Medical Assistance.

Through the Rule 25 process, counties/Tribes are not obligated to authorize any particular service beyond those required in Minnesota Administrative Rule 9530.6622, Subp. 1-6. For clients accessing services through the Rule 25 process, the county/tribe will still be issuing a Service Agreement that the provider will utilize and process as they always have.

There is nothing that currently prohibits a county from billing treatment coordination while an individual is simultaneously in residential treatment. We encourage the county to work with the treating program to identify what type of treatment coordination the county is doing versus the program. The residential program is expected to be providing treatment coordination to the client according to licensing requirements. The county and residential provider would need to be able to work together to determine who is doing what in regards to the elements within treatment coordination as it is defined in 245G.07 (a) (5) so there isn’t duplication of efforts.

Direct Access allows for an individual to choose where they would like to access treatment by removing Rule 25 placing authority and the MMIS Service Agreement which dictates the provider and units authorized by the placing authority. Individuals will be able to seek out the provider of their choice. In the Direct Access process there is no service agreement with a specified level of care and treatment location that the individual must follow. The new process will allow for the individual to have a comprehensive assessment completed and then choose the provider and level of care they would like to participate in; up to the highest level of care determined necessary. i.e. An individual may be assessed for residential level of care, but due to a number of circumstances they are only willing to participate in nonresidential care. This is an example of downward deviation occurring.

During the parallel process, it is important that we assist those seeking treatment in understanding that there are different ways to go about accessing treatment. An individual may want to go to the placing authority and follow the Rule 25 process. We hope that no matter the individual’s entrance into treatment they are aware of their options. At this time, there is no specific form or notification that has been developed to inform clients of their choice.

DHS would encourage that the criminal justice system support client choice, however, DHS does not have oversight or the ability to dictate the role of a judge. The court has the authority to require the individual to follow the recommendations of the comprehensive assessment. The client has the choice to negotiate with the court if they cannot/or do not want to follow the recommendations of a comprehensive assessment.

Licensed SUD treatment programs must admit the client and follow all licensing standards, including timelines and paperwork, in order to provide any treatment services.

Although licensed professionals in private practice are not held to all the same standards that SUD licensed programs are, if the properly MHCP enrolled provider plans to provide treatment services for the individual, they should complete a DAANES admission record and document accordingly. Please also note, as indicated in 254B.05, licensed professional in private practice are not eligible to provide peer recovery support services.

Counties and tribes may begin billing for treatment coordination (as long as they are enrolled with Minnesota Health Care Programs to bill for the service) after the completion of a comprehensive assessment or if authorized based on a Rule 25 assessment and a SA is issued for the service. Counties and Tribes not enrolled to provide formal outpatient treatment do not complete DAANES admission records at this time, only assessment records.

Although there are portions of SBIRT and the associated services that this may authorize are included in statute, this has not yet been implemented. Until this process has been fully implemented, the above response applies.

A licensed professional in private practice is an eligible vendor identified in 254B.05, subdivision 1. This section of the statute identifies the services this individual is eligible to provide. There is a definition of a licensed professional in private practice is located in 245G.01, subdivision 17, which does not allow for multiple licensed professionals to affiliate to provide alcohol and drug counseling. If you are unsure whether or not you need a 245G program license, please contact DHS licensing.

Licensed professionals in private practice are not licensed by DHS, rather they are held to the standards of their applicable governing licensing board. It is the provider’s responsibility to be well versed in these rules and regulations and reach out to their board if they have questions.

Licensed professionals in private practice need to be enrolled with Minnesota Health Care Programs in order to bill for services. See 254B.05 subdivision 1 (b) for details of what qualifies an individual to enroll and what services they are eligible to provide. For more information on enrollment for SUD services, you can refer to the SUD Services Enrollment Criteria and Forms page.

The comprehensive assessment and comprehensive assessment summary go hand in hand, and are sometimes just referred to as the comprehensive assessment. There is no single, Commissioner approved or mandated “tool” or form for a comprehensive assessment. There are elements that are required to be included in the comprehensive assessment and summary and this can be found 245G.05.

In the Rule 25 assessment there was a built in mental health screening. The comprehensive assessment also requires a mental health screening with a tool approved by the Commissioner (245G.05 Subd. 1 (8)). Currently the entirety of the GAIN-SS must be completed and maintained in the client record. If the individual has a total score of 1 or more in the IDScr section, the screen would be considered a positive mental health screen. According to the GAIN-SS manual (2005), a score of 1-2 indicates a “Moderate (1 to 2) A Possible Diagnosis; the client is likely to benefit from a brief assessment and nonresidential intervention.”

The comprehensive assessment does not have specific timelines (outside of licensing requirements) in regards to when an update needs to be completed or how long a comprehensive assessment can last. Whenever admitting an individual to services, it is the responsibility of the provider to review the most current comprehensive assessment and update necessary information. There will be a number of historical pieces that will not have changed, but there needs to be enough current information to justify the level of care being received based on the client’s severity ratings.

A provider completing a comprehensive assessment must ALWAYS input that information into the DAANES assessment tab, whether or not the individual will be receiving services from you or not, and regardless of funding stream. For public pay clients, the completion of the DAANES assessment record is required in order to be eligible for reimbursement.

A residential provider can bill for the comprehensive assessment that they do for a client who is referred to another facility or enters treatment with them on a different day than the comprehensive assessment was done. If the assessment is done on the same day as the client begins residential treatment, and by the same provider, then it is included in the per diem rate for that residential provider. If the comprehensive assessment is done as a tool to refer the client to appropriate services at a different facility, and its done prior to admission into a program, residential providers can bill for it.

Both the Substance Abuse Mental Health Services Administration (SAMHSA) and Centers for Medicare and Medicaid Services (CMS), federal funders of the Behavioral Health Fund, continue to focus on timely access to treatment and state responsibility to manage access and client wait times. In addition, through the receipt of the Federal Block Grant Minnesota is required to assure that pregnant women, pregnant injecting women, and drug injecting users are given priority access to services. If your agency is not able to provide an assessment in a timely manner or there is a waitlist, additional resources for other providers could be given to the individual seeking an assessment.

Eligible providers for SUD can be found in 254B.05. Please review the Minnesota Health Care Programs Substance User Disorder Services Enrollment Criteria and Forms page. It is also important for you to be aware of the Substance Use Disorder provider manual page. Please reach out to the Provider Call Center at 651-431-2700 with additional enrollment questions.

Please refer to the Substance Use Disorder (SUD) Services section of the Minnesota Health Care Programs (MHCP) Provider Manual for billing policy. For questions about fee-for-service coverage policies and billing procedures provided to MHCP members, contact the Provider Call Center at 651-431-2700 or 800-366-5411. Communication regarding billing may not always come through a Behavioral Health e-memo as our division works primarily on policy, so please keep an eye on MHCP provider news and updates webpage and your MN–ITS mailbox.

We recommend that all counties and tribes use Behavioral Health Fund Request to be consistent across the state. We also recommend that even after the client is determined as eligible for the behavioral health fund, the provider assist the client in getting access to medical assistance, which will help provide better overall access to care for the client.

The Behavioral Health Fund (BHF) is available for clients seeking SUD services in jails, even if Medicaid is not an option. Counties must establish financial eligibility (Rule 24).

All eligible vendors of substance use disorder services need to complete DAANES. Depending on the type, there are different DAANES records that need to be completed. For licensed SUD providers, all comprehensive assessments and every episode of treatment needs to be entered into DAANES. For Counties/Tribes (those not also licensed as SUD treatment providers) and Recovery Community Organizations, only the DAANES assessment needs to be completed in order to begin to provide any services. The data entry into DAANES can be done by any staff who has access. This is a decision that your facility makes regarding work flow.

DAANES has 5 different record types: assessment, admission, 6 month update (Opioid Treatment Program only), treatment service and discharge. Depending on what type of service you are enrolled to provide, that determines which records you will complete. The assessment record is completed by all enrolled substance use disorder providers. The admission record is completed by eligible vendors who are enrolled to provide residential and/or nonresidential treatment services. Within the admission record, eligible vendors are able to create treatment service records for the Direct Access 00 covered clients using the Behavioral Health Fund and no service agreement. The discharge record is completed by all providers who have entered an admission record. The six month update record is completed at 6 months intervals by Opioid Treatment Programs.

DAANES connects to the billing system using the client’s PMI and coverage type selected. The claims systems processing is dependent and determined based on the coverage type selected within the DAANES admission.

If an update assessment record is required due to establishing a new financial eligibility span for a client, a substance use disorder treatment provider may use the severity ratings and assessment date from the most current treatment plan review. If an updated assessment record is required for a county/tribe or Recovery Community Organization, they would need to have a qualified individual determine current severity ratings by doing a comprehensive assessment update and have this documented in their records.

If the provider receives a Rule 25 assessment, the provider can complete the DAANES assessment tab by indicating they are using an existing assessment. This would then allow the provider to move forward with completing a DAANES admission. The provider would still need to complete the comprehensive assessment within the timeframes indicated in 245G.

A provider cannot complete a Rule 25 assessment and bill for it as if it were a comprehensive assessment.

Contact the DAANES support desk (dhs.daanes@state.mn.us) and request a user registration form. It will be emailed to you. You fill that out and return to either the fax on the form or to the email you received it from. Make sure to fill the form in completely.

Please email dhs.daanes@state.mn.us and they will be sent to you.