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Medical Assistance rates for mental health services

The current fee-for-service (FFS) rates for mental health services are included in the below table and are updated to reflect the most current maximum allowed, FFS rate for the code. The table also explains when services are reimbursed at an adjusted rate in certain circumstances.

Mental Health Codes and Rates

2016 Mental Health Rates Study Information

Thank you for your interest in an unprecedented opportunity to inform the Legislature about the costs to deliver mental health services. DHS is collecting cost data on Crisis, Diagnostic Assessment, Outpatient Mental Health and Substance Use Disorder, and Rehabilitative Mental Health services at this time. DHS will use cost data collected from providers, along with other rate methodology components to inform potential improvements to rate-setting methodology. DHS will involve ACT, Residential Crisis, IRTS and Children’s Day Treatment providers in a separate process to follow-up on recommendations from the 2015 Intensive Service Rate Study.

As an initial step please review Appendix A of the cost report instructions to confirm that your organization provided at least one of the listed services during calendar year 2015 before completing the cost report.

Direct questions related to completing the cost report to Adam Sery at Adam.Sery@mercer.com.
Please submit completed cost reports to DHS.AdultMHFunding@state.mn.us by January 13, 2017.

Medical Assistance payment for intensive rehabilitative services

Assertive Community Treatment (ACT), Intensive Residential Treatment Services (IRTS) and Residential Crisis Services (RCS)

These three mental health services utilize a prospective cost-based rate setting methodology to establish a per diem rate for individual service providers. The total per diem is the sum of the provider’s direct service costs, other program costs, and physical plant costs (for residential rehabilitation service providers only).

2017 Rate Setting Manual for existing and new programs

The Rate Setting Manual - ACT/IRTS/RCS manual is updated annually in August of each year

Current Program FY16 Actual Expenditures Worksheet

Spreadsheets are updated annually in August of each year to establish program rates for the following calendar year

NEW Program Expenditures Worksheet

Spreadsheets are updated annually in August of each year to establish program rates for the following calendar year

Settle-Up Process for ACT/IRTS/RCS

A settle-up process is utilizes for circumstances when there is a change in ownership of an ACT, IRTS, or RCS program.

  • Settle- up Spreadsheet – please contact the division.

Rate-Setting for Adult Mental Health Targeted Case Management (AMH-TCM)

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.

MH-TCM Billing Procedures

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.

Cost-based Rate Setting References

The Medical Assistance (MA) payment for intensive rehabilitative services (ACT, IRTS, and RCS) is established through a cost-based methodology defined in 256B.0622, Subd. 8.

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