Integrated Treatment for Co-Occurring Disorders
Integrated Treatment for Co-Occurring Disorders (IT-COD) is considered an evidence-based practice because research shows in contrast to the “system as usual” approach, individuals with co-occurring disorders experience improved treatment outcomes when they receive this holistic, specialized form of treatment. In this model, the contributions of professionals from both the mental health and substance use fields are merged into a single treatment regimen and setting. Minnesota Rule 9533.0010, Applicability subp. 2. Optional Certification, briefly describes how this rule is a supplemental or “add on rule.” This means the certification is supplemental to a pre-existing authorization by the department (or other governing body) to operate a previously existing mental health or chemical dependency service. Thus, the new rule adds a supplemental layer of specialized requirements focused solely on the provider’s IT-COD program. Minnesota Rules, parts 9533.0010 to 9533.0180 describe IT-COD in its entirety.
What services are available?
Minnesota Rule 9533.0060 Program Structure and Practice Principles identify the various components of IT-COD.
Who is eligible for this service?
The target population is defined in Minnesota Rule 9533.0040 Target Population.
Certification is voluntary. At this time individual and program certifications are being developed. When a program is IT-COD certified, the new rule requirements supersede any previously existing department rule requirements as IT-COD establishes a higher standard of care than other rules. Eligibility for certification is provided in Minnesota Rule 9533.0030 Eligibility for Certification.
Currently, there is not a procedure-specific code for IT-COD. Agencies providing IT-COD counseling techniques use traditional mental health codes such as a diagnostic assessment (an extended diagnostic assessment allows for payment of a more extensive, in-depth assessment of the two disorders) and individual and group psychotherapy. DHS will be evaluating how IT-COD services fit within the new chemical dependency rate structure for co-occurring services. The legislature did not appropriate funds for integrated dual diagnosis treatment, but directed the department to “apply for any federal waivers necessary to secure, to the extent allowed by law, federal financial population. Minnesota Statutes, section 245.4863, paragraph (c). Review is underway to seek this federal financial participation. Until that occurs, reimbursement for integrated dual diagnosis treatment will occur based on the traditional reimbursement categories for discrete mental health and chemical dependency treatment services.
As certified programs are implemented across the state, the department will obtain valuable treatment outcomes data from these programs, which will help refine the fluid process of creating individual and program certifications for IT-COD. The department will analyze the data to identify patterns and seek to further improve health care outcomes for the individuals served in these programs. At this time, Minnesota Rule 9533.0160 Quality Assurance and Improvement, outlines basic guidelines for reporting and data collection. In addition, all participants are required to report client-level data to MHIS (Mental Health Information System)
IT-COD Policy Lead, 651-431-2225
Minnesota Center for Mental and Chemical Health is currently conducting a pilot with 6 teams using the Enhanced-Illness Management Recovery curriculum. Please refer to their website for continual updates and monthly webinars on IDDT principles and concepts.
Three screening tools have been approved by the commissioner: GAIN SS, CAGE AID, and CRAFFT. Below are the web links and purpose for each. Minnesota Rule 9533.0180 Standards for Proposed Additional Screening Tools outlines requirements for commissioner approved screening tools.
Username: gainssuser; Password: 1105
Approved users under license agreement between DHS and tool developer:
- Enrolled Minnesota Health Care Program Providers;
- MCO contracted providers with the Minnesota Department of Human Services;
- Approved treatment providers licensed under Minnesota Rule 31;
- Minnesota county social service and county juvenile corrections staff;
- Approved assessors under Minnesota Rule 31;
- Approved Minnesota gambling treatment providers;
- Minnesota Department of Human Services State Operated Services;
- Minnesota tribal entities
Purpose of GAIN SS: Co-joint screener for use with ages 12 and older to identify mental health symptoms, substance use disorder and criminal/violent behavior
(Available in public domain)
Purpose of CAGE AID: Used to screen ages 10 and old for substance use disorders
(Available in public domain)
Purpose of CRAFFT: Used to screen adolescents aged 12-21 for high risk alcohol and other drug use disorders approved for use within hospital settings only. Multiple language translations available. Versions available for either clinician or self-administration.
Standards of care endorsed by SAMSHA, which have informed the proposed rule and contain requirements that correspond to seven specific areas: program structure, program milieu, assessment, treatment, continuity of care, staffing and training.