Frequently asked questions for certified behavioral health home (BHH) services providers

Is the six-month review of the health action plan rolling or do providers need to review the health action plan every six months?

The review requirement is a rolling requirement. BHH services providers must review with the person his or her health action plan at least every six months. The expectation is that the BHH services team will update the health action plan whenever there is a change in the person’s goals or circumstances.

Is a signature required on the health action plan?

The person receiving services does not actually need to sign, although that is a best practice. They do need to be provided a copy.

How often does a person’s health wellness assessment need to be updated?

BHH services providers must gather the information linked to each required health wellness assessment (HWA) element within 60 days of intake. Beyond this, DHS does not have a required timeline for updating the HWA. DHS only expects that BHH services providers update the information associated with the HWA as needed. 

When exactly does the integration specialist have to see the person receiving services?

The integration specialist is required to review the health action plan for each person served. However, there is not a specific requirement for when and if the integration specialist must see the person. 

Are people who are dually eligible for Medical Assistance (MA) and Medicare eligible for BHH services? Do we have to be a Medicare-enrolled provider to offer BHH services?

A dual-eligible person can receive BHH services. A BHH services provider does not need to be enrolled as a Medicare provider. MA should be billed as the primary for BHH services. 

Are BHH services providers able to request a variance?

Yes. Providers can request a variance on specific service delivery requirements. To request a variance, complete and submit the BHH services variance request form.

Can a provider bill for a unit of community health worker time separate from BHH services?

Yes. As long as the provider can demonstrate that all requirements for billing for a community health worker have been met, a provider can bill for the community health worker. For more information about community health worker billing requirements, see the community health worker section of the MHCP Provider Manual.

A community health worker can meet the professional qualification requirements of a qualified health home specialist or a systems navigator for BHH services. A provider who chooses to bill for two separate services is responsible for demonstrating that the requirements for payment for both services have been independently met. 

Can providers get a copy of the enhanced BHH services payment report that DHS provides to managed care organizations (MCOs)?

This report was designed specifically for the MCOs. BHH services providers are able to access claims data for all individuals served through the Minnesota Partner Portal. The Minnesota Partner Portal will show the number of times that any provider has billed the S0280-U5 code for the $350 enhanced BHH services payment for an individual.

Do BHH services providers need to list a treating provider on the claim? Are there different requirements for this between fee-for-service (FFS) and managed care claims?

Please refer to the BHH services section of the MHCP Provider Manual.

Can BHH services providers bill MA for interpreter services or MA transportation services when needed for the provision of BHH services?

Yes. Please review the MHCP Provider Manual Access Services and the MHCP Provider Manual Nonemergency Medical Transportation (NEMT) Services sections.

What is the eligibility criteria for a person to receive BHH services?

The BHH services statute says that to be eligible for BHH services, a person must be eligible for medical assistance and have a condition that meets the definition of mental illness as described in section section 245.462, subdivision 20, paragraph (a), or emotional disturbance as defined in section 245.4871, subdivision 15, clause (2).

When does a DA need to be completed for a person receiving BHH services?

Individuals receiving BHH services will be required to obtain a DA within six months of intake completion for BHH services.

Without a current DA, how do we determine a person’s initial eligibility for BHH services?

To be eligible for BHH services without a DA, an individual must have a current diagnosis from a qualified health professional of a condition that meets the definition of mental illness as described in section 245.462, subdivision 20, paragraph (a), or emotional disturbance as defined in section 245.4871, subdivision 15, clause (2). For BHH services, DHS considers a “current” diagnosis to be one made within the past 12 months by a qualified professional. Qualified health professionals include: 

• Physician 
• Physician’s Assistant  
• Advanced Practice Registered Nurse 
• Licensed Mental Health Professional

What if an individual has a current DA in place?

If a current — within the past 12 months — DA is in place, another DA is not needed at the time the person starts BHH services, nor within six months of enrollment into BHH services.   

Does the DA need to be reviewed and how do we document eligibility?

A mental health professional (MHP) employed by or under contract at your organization must review the diagnostic assessment. An MHP is not required for determining if the person has an allowable mental illness diagnosis made within the past 12 months by a qualified professional. Any member of the team or at the organization can confirm those eligibility requirements. 

BHH services providers must determine and document an individual’s eligibility before providing and billing for BHH services. The list of allowable mental health diagnostic code ranges under which providers can bill for BHH services is available on the mental health diagnostic codes section of the Minnesota Health Care Program (MHCP) provider manual.

Is health care home care coordination duplicative when paid through an MCO?

It depends on how the MCO is paying the care coordination fee. If the MCO is making a global prospective payment to the health care home for all care coordination services, then BHH services are not considered duplicative. However, if the MCO is paying the health care home for each unit of care coordination services provided, then the person cannot receive BHH services in the same month. We recommend that BHH services providers communicate with their local health care homes to determine if the payment is duplicative with payment for BHH services.

A person may receive his or her primary care and mental health services from a certified health care home and also be a recipient of BHH services. A key component of BHH services is to ensure that people with serious mental illness are connected to primary care. Therefore, we encourage people to receive their primary care through a health care home. Health care home is a model of care delivery for primary care services in Minnesota.

Can BHH services be provided to a person on a Community Access for Disability Inclusion (CADI) waiver?

Yes. BHH services are not considered to be duplicative of the case management services provided by a CADI case manager. Review the MHCP Provider Manual BHH services section for more information about services that are considered duplicative of BHH services.

The CADI case manager has expertise in community supports and services specific to individuals who meet the CADI eligibility criteria. The BHH services provider must coordinate with the person’s CADI case manager to ensure that duplication is avoided and that all care and services are coordinated. Review the CADI section of the Community-Based Services Manual (CBSM) for more information about CADI requirements and services.

Can BHH services providers modify the BHH Services Rights, Responsibilities and Consent form DHS-4797B (PDF) to save the provider’s contact information in the form?

Yes. If the provider has the full Adobe suite, the provider can save the static provider contact information on the form. Providers cannot change the text written by the state.

Can BHH services providers generate or repopulate the form in our electronic health record (EHR) and get an electronic signature from people?

Yes. Providers who have the full Adobe suite can generate or repopulate the BHH Services Rights, Responsibilities and Consent form DHS-4797B (PDF) within their EHRs. However, the text and format of the form cannot be changed.

If a person we provide BHH services to switches to a different MCO, do we need to tell the new MCO that the person is receiving BHH services?

Yes. The reason DHS requires BHH services providers to notify the MCO is to ensure that services are coordinated and that care coordination services are not duplicated. Additionally, BHH services providers must notify the MCO that an enrollee is receiving BHH services because some MCOs will need to do programming to ensure that BHH services claims pay.

Are the staffing ratios pro-rated based on percentage of people served (example: 112 people requires at least a .5 FTE integration specialist) or is it based on a range (example: 0-224 would require 1.0 FTE integration specialist)?

Standard 3F requires that providers maintain the following shared caseload ratios:

• One full-time equivalent (FTE) integration specialist for every 224 members
• One FTE systems navigator for every 56 members
• One FTE qualified health home specialist for every 56 members

BHH services providers must have staff adequate to deliver the required BHH services. The BHH services caseload ratios were developed with the assumption that the caseloads would be implemented on a pro-rated basis depending on the size of the population served. BHH service providers may incrementally increase staffing based on the growth and needs of the populations served. Teams must share a caseload so that every person has access to the expertise and services provided by each of the three unique BHH services team members as needed.

Is there any flexibility in the required staffing ratios?

The caseload size is based on our actuarial work that assessed the required BHH services, time to complete the service, and team member responsible for the service. There is flexibility so that providers can exceed the ratios by up to 25 percent across the BHH services team.

BHH services providers serving fewer than 100 people may utilize an adjusted staffing ratio of a minimum of .5 FTE integration specialist and 1 FTE systems navigator to serve these recipients. Upon serving more than 100 BHH services recipients, providers must meet and maintain the BHH services staffing ratios outlined in BHH services standard 3F.

Does a BHH team member have to spend 100 percent of his or her time in the BHH role?

Providers must meet the caseload by maintaining the full time equivalent (FTE) as identified for each BHH team member. There may be instances where more than one person fills the required 1.0 FTE. 

• The 1.0 FTE integration specialist can be split between two people, at .50 FTE per person. 
• The 1.0 FTE for systems navigator can also be split between two people at .50 FTE per person. 
• The 1.0 FTE qualified health home specialist can be split across up to four people, with at least .25 FTE per person.