Service rates information

Overview

The goals of the Mental Health Critical Access Rate Increase are to increase access to mental health service for Minnesota Healthcare Programs (MHCP) and underinsured recipients.

 Providers that meet the eligibility criteria must submit a request for designation with all other required documentation.

 All aspects of the Mental Health Critical Access Rate Increase are subject to change by the Minnesota Legislature.

Eligible Providers

Minnesota Healthcare Program (MHCP) enrolled providers that are:

• Mental health clinics and centers licensed under Minnesota Rules, parts 9520.0750 to 9520.0870, or hospital outpatient psychiatric departments that are designated as essential community providers.

Critical Access Designation Request

For mental health clinics and centers that are not designated as essential community providers by the Minnesota Department of Health (MDH) complete the Critical Access Mental Health Applicant Assurance Statement (DHS-7689)

 For essential community providers fax your designation letter from MDH, along with the NPI(s) of the designated providers/locations, to MHCP Provider Enrollment at 651-431-7462

Reimbursement for Services

Providers designated as Critical Access Mental Health providers will receive a 23.7% increase above the MHCP maximum allowable rate.

 Fee-for-service (FFS) add-on payments are included in the reimbursement for each paid claim and appear on the provider’s remittance advice.

There are four types of AMH-TCM provider agencies:

1. In fee-for-services (FFS) model, a County-run provider agency enrolled in the Minnesota Health Care Programs (MHCP) as a recognized provider (245.4711);
2. In (FFS) model, a County-contracted provider agency enrolled in the MHCP as a recognized provider (245.4711);
3. In (FFS), a Tribe-run provider agency enrolled in the MHCP as a recognized provider; or
4. In pre-paid managed care model, a managed care organization (MCO) -contracted provider.

There is a different rate setting method for each of these types:

1. In FFS, a County-run provider agency’s reimbursement is a monthly rate determined by an annual time and cost study methodology that considers the county’s overhead costs, staff costs, caseload sizes, and a time study of case manager’s activities. Monthly rates will vary from county to county. At least one qualifying case management services must be provided to the recipient during the month.
2. In FFS, a County-contracted provider agency’s reimbursement is a monthly rate determined by the county that the contracted provider agency provides services within. The county functions as an extension of the State in determining the rate. The County-contracted provider agency must have a service contract with each of the counties that the agency provides services in. At least one qualifying case management services must be provided to the recipient during the month.
3. In FFS, a Tribe-run provider agency’s reimbursement is a Federal encounter rate for each qualifying face-to-face contact with a case management service recipient. The encounter rate is determined annually between the Federal government and the Tribe.
4. In pre-paid managed care model, the MCO- contracted provider agency’s reimbursement is a monthly rate determined by negotiations between the agency and the MCO. The agency must have a contract (or formal agreement) or recipient-specific authorization with the recipient’s MCO to provide AMH-TCM services to eligible enrollees of the MCO. At least one qualifying case management services must be provided to the recipient during the month. MCOs have the option to reimburse with “tiered” monthly rates based on the MH-TCM service intensity or recipient level of care need. The provider agency bills and is reimbursed by the MCO; not DHS. DHS pays the MCO a capitation to manage health care services, including MH-TCM, for the enrollees of the MCO.

Bill MH-TCM services online using MN–ITS 837P

Counties and county-contracted vendors: Bill one claim per month.

Tribes and FQHCs: Bill one claim per encounter. Enter the date of service.

Do not enter a treating provider NPI number on each line item.

MH-TCM claims will deny when a face-to-face contact occurs within the preceding two months prior to a change in eligibility status and the first contact under the new eligibility status (if client changes provider agency, county, MCO) is a telephone contact. For reimbursement during the month, there needs to be a face-to-face contact in the month when there is a change in eligibility state. Providers must resubmit the claim with case notes documenting the face-to-face contact using the AUC cover sheet.

Mental Health Codes and Rates – open the PDF, click on the first link, go to page 2 of 6 to view the Case Manager Codes.

Note: In “pre-paid managed care” model, the MCO-contracted provider of MH-TCM is reimbursed a monthly rate negotiated between the provider agency and the MCO. The monthly rate is paid if at least one case management core service component is provided consistent with the recipient’s ICSP in at least one face-to-face contact with the recipient during the month. MCOs have the option to reimburse with “tiered” monthly rates based on the MH-TCM service intensity or recipient level of care need. The MCO determines if telephone contact with the recipient will be a reimbursed service.

The provider agency bills and is reimbursed by the MCO; not DHS. DHS pays the MCO a capitation to manage health care services, including MH-TCM, for the enrollees of the MCO.