Mental Health Services

Definitions

Child with Emotional Disturbance (ED): A child with an organic disorder of the brain, or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that:

  1. Is listed in the clinical manual of the International Classification of Diseases, 10h Revision, Clinical Modification (ICD-10-CM), code range 290.0 – 302.99 or 306.0 – 316.0 or the corresponding code in the Diagnostic and Statistical Manual of Mental Disorders (DSM-MD), Axes I, II, or III; and
  2. Seriously limits a child’s capacity to function in primary aspects of daily living such as personal relations, living arrangements, work, school, and recreation.

ED is a general term and intended to reflect all categories of disorder described in the DSM-MD, as usually first evident in childhood or adolescence.

Clinical Supervision: Clinical supervision is the documented time a clinical supervisor and supervisee spend together to discuss the supervisee’s work, to review individual member cases, and for the supervisee’s professional development. It includes the documented oversight and supervision responsibility for planning, implementation, and evaluation of services for a member’s mental health treatment.

Evaluation and Management (E/M): E/M codes are used to report services provided in a physician’s office or outpatient setting or other ambulatory facility, or services provided to an individual who is an inpatient in a hospital. For mental health services, providers must follow the Current Procedural Terminology (CPT) guidelines when using these codes unless otherwise specified in the coverage text for a mental health service.

Hour: A 60-minute session of mental health service. At least 45 minutes of the period must be spent in face-to-face contact with the member. The other 15 minutes may be spent in member-related activities, such as scheduling, maintaining clinical records, consulting with others about the member’s mental health status, preparing reports, receiving the clinical supervision directly related to the member’s psychotherapy session, and revising the member’s individual treatment plan (ITP).

If the period of service is longer or shorter than one hour, up to one-fourth of the time may be spent on member-related activities.

Individual Community Support Plan (ICSP): A written plan developed by a case manager on the basis of a diagnostic assessment (DA) and functional assessment (FA) that identifies specific services needed by an adult with Serious and Persistent Mental Illness (SPMI) to develop independence or improved functioning in daily living, health and medication management, and social skills.

Individual Treatment Plan (ITP): A written plan developed by a mental health professional or mental health practitioner of intervention, treatment, and services for a member.

Mental Health Crisis: A behavioral, emotional, or psychiatric situation that would likely result in significantly reduced levels of functioning in primary activities of daily living (ADL) or in the placement of the member in a more restrictive setting (e.g., inpatient hospitalization).

Mental Health Emergency: A behavioral, emotional, or psychiatric situation that causes an immediate need for mental health services (e.g., 911 call, emergency department visit, or inpatient hospitalization).

Mental Illness: An organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that is listed in the ICD-10-CM.

Psychotherapy Session: A planned and structured face-to-face treatment episode between the provider of psychotherapy and one or more individuals. A psychotherapy session may be individual psychotherapy, family psychotherapy, or group psychotherapy.

Rehabilitative Services: Day treatment, partial hospitalization, Adult Rehabilitative Mental Health Services (ARMHS), Children’s Therapeutic Services and Supports (CTSS), and crisis response.

Serious and Persistent Mental Illness (SPMI): Case management services may continue to be provided for a child with a serious mental illness who is over age 18, but under age 21.

For purposes of case management and community support services, a “person with serious and persistent mental illness [SPMI]” means an adult who has a mental illness and meets at least one of the following criteria:

  1. The adult has undergone two or more episodes of inpatient care for a mental illness within the preceding 24 months
  2. The adult has experienced a continuous psychiatric hospitalization or residential treatment exceeding six months’ duration within the preceding 12 months
  3. The adult has been treated by a crisis team two or more times within the preceding 24 months
  4. The adult:
  1. Has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline personality disorder;
  2. Indicates a significant impairment in functioning; and
  3. Has a written opinion from a mental health professional, in the last three years, stating that the adult is reasonably likely to have future episodes requiring inpatient or residential treatment, of a frequency described in clause 1 or 2, unless ongoing case management or community support services are provided.
  1. The adult has, in the last three years, been committed by a court as a person who is mentally ill under MN Stat. Chap. 253B, or the adult’s commitment has been stayed or continued
  2. The adult:
  1. Was eligible under clauses 1 – 5, but the specified time period has expired or the adult was eligible as a child under MN Stat. sec. 245.4871, subd. 6; and
  2. Has a written opinion from a mental health professional, in the last three years, stating that the adult is reasonably likely to have future episodes requiring inpatient or residential treatment, of a frequency described in clause 1 or 2, unless ongoing case management or community support services are provided.

Serious Mental Illness: Case management services may continue to be provided for a child with SED who is over age 18, but under age 21.

For purposes of eligibility for case management and family community support services, “child with serious mental illness” means a child who has a mental illness and who meets at least one of the following criteria:

  1. The child has been admitted within the last three years or is at risk of being admitted to inpatient treatment or residential treatment for a mental illness; or
  2. The child is a Minnesota resident and is receiving inpatient treatment or residential treatment for a mental illness through the interstate compact; or
  3. The child has one of the following as determined by a mental health professional:
  1. Psychosis or a clinical depression or
  2. Risk of harming self or others as a result of a mental illness; or
  3. Psychopathological symptoms as a result of being a victim of physical or sexual abuse or of psychic trauma within the past year; or

The child, as a result of a mental illness, has significantly impaired home, school, or community functioning that has lasted at least one year or that, in the written opinion of a mental health professional, presents substantial risk of lasting at least one year.

 

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Updated_12/22/2025