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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 youth 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.
* Family will be used throughout the remainder of the document
Question: Is the Children’s Residential Service Path available to all Minnesota youth, 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 youth 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 youth 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: 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 youth 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 youth has a SED and contain a recommendation indicating the MHP believes it is medically necessary for the youth 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 youth’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 youth’s condition and assigns the level of care a youth 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 youth is enrolled? Should they contact the MCO if a youth is within the MCO network?
Answer: Yes, both the non-initiative tribe, if the youth is enrolled, and the MCO, if the youth is within a MCO network, must be contacted and involved.
The county must submit a Minnesota Indian Family Preservation Act (MIFPA) notice if an American Indian/Alaskan Native youth has been referred to the agency. The DHS ICWA page provides guidance about the MIFPA process. If the child is found to be enrolled and the tribe becomes involved, it is important to remember that the tribe is a sovereign nation and must be an active voice in accordance with the family’s choice of involvement.
The MCO will pay for the child’s mental health services within the RTC. If the child is enrolled with a MCO network or has private insurance, the MCO or private insurance company is responsible for payment of mental health services. The county must inform the MCO’s when the youth 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. Allocations for CMH residential services treatment will be distributed on a calendar year basis; county CY2022 and CY2023 allocations. Further county or initiative tribe involvement will be determined by the family.
Question: When can a family request a case manager from the county? Before, during or after the child has entered the residential service?
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 youth 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 youth 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 RTC. The county or initiative tribe bill TCM as long as the case manager is performing case management activities.
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 youth.
The county or initiative and the RTC should discuss how they will work together to ensure children from the county 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 RTCs may deny admission for other reasons. The youth may have behavioral or mental health concerns or the licensed RTC may not have beds available at the time of referral.
Question: Does the county have the ability to direct the family about which RTC they must use?
Answer: If the family requests assistance in locating a service, the county will assist them. The county will not direct the family. The family chooses which licensed RTC they would like to use.
Question: How will the licensed RTC help and support the family in planning for the discharge from the RTC?
Answer: The RTC 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 RTC 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 RTC should ask the family who they feel safe with and who they think provides the best support. The licensed RTC will schedule a meeting to review the child’s treatment in the licensed RTC every 60 days.
Question: When a youth is within a MCO network or has private insurance, how does that work?
Answer: If the youth has Medical Assistance (MA), MA pays for the mental health services. If the youth is enrolled in a MCO network or has private insurance, the MCO or private insurance pays mental health services. The county or initiative tribe will continue to pay room and board as long as the allocation is available.
Question: How does the county or initiative 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 counties or initiative tribes develops or uses to track the allocation utilization. The county or initiative tribe will make budget decisions independent of DHS.
Question: What is the county’s role in informing the families of the funding?
Answer: It will be important for the county to assess if they have the allocated funds before informing the family if they are able to pay for the service. If funds are available before the family, county or initiative tribe attempts to locate a CMH Residential Service and are not after it is located, the county or initiative tribe must inform the family of this change in status.
Question: In instances where a youth under the of 18 enters a RTC 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 decide the county or initiative tribe 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 youth to enter the setting or would rather use the allocation with other youth they believe to be in greater need, does the county or initiative tribe have the right deny the service?
Answer: No, the county or initiative does not have the right to deny the family and child access to this service if the county has monies available from their allotment.
Question: Does the CMH residential services pathway apply to youth who are already in a licensed RTC 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 doesn’t meet criteria?
Answer: When the insurance benefit has exhausted or will not provide the payment, the family can bring a DA containing the necessary recommendations to the county. If the county has funding, the family is eligible for this service.
Question: Is the county or initiative tribe responsible for payment of the service after the allocation runs out?
Answer: The allocation covers expenses formerly paid by federal Title IV-E funds. Title IV-E reimbursement coves a portion of the cost for foster care (room and board) for eligible children in eligible facilities. This is a finite allocation. The county is not responsible for paying beyond their allocation. Counties and initiative tribes are encouraged to speak with their legal counsel about this matter.
The county or initiative tribe 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 youth is in the setting. If the family would like to have the youth remain in the setting, a county or initiative tribe case manager will be assigned. If the family would like to apply for TEFRA, the case manager should assist the family if requested. The family will be asked to sign a voluntary placement agreement. 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 RTC utilization data. The data was extracted from CY2018 moving forward. Allocations for the CMH residential services path will be distributed on a calendar year basis to counties and initiative tribes. Readers can locate the county CY2022 and CY2023 allocations within the Residential Services Path Calendar Year 2022 Allocation (PDF).
Question: What statutes direct the CMH Residential Services Path?
Answer:
The DHS Financial Operations Division will not issue the CY22 payment until after 05.27.2022. This ensures DHS provides payments solely to the counties and initiative tribes that intend to use the CMH Residential Services Path funding. No payments have been issued to date.
Question: What happens if a county or initiative tribe has underspending?
Answer: A county or initiative tribe is not able to roll CY22 funds into CY23. The CY22 allocation will be paid as a one-time lump sum payment. Counties and initiative tribes will report their expenditures during CY22. If the total expenditures are less than the allocation at the end of CY 22, the county or initiative tribe will need to repay the unused portion.
