Uniform Service Standards FAQs

Because of the complexity of the State Plan Amendment (SPA) required to enact USS, the implementation of USS was delayed from our original projections. DHS has now received approval from Centers for Medicare and Medicaid Services (CMS). USS standards will go into effect 10/17/22, to give providers time to implement.

The Uniform Service Standards (USS) creates new licensing and certification requirements for the following types of programs and services:

• Intensive Residential Treatment Services (IRTS)/Residential Crisis Stabilization (RCS) Programs
• Mental Health Clinics (Formerly Rule 29, now 245I.20)
• Assertive Community Treatment (ACT)
• Adult Rehabilitative Mental Health Services (ARMHS)
• Mobile Crisis Teams
• Children's Therapeutic Services and Supports (CTSS)
• Intensive Treatment in Foster Care (ITFC)
• Intensive Nonresidential Rehabilitative Mental Health Services (IRMHS)
• Covered Services under 256B.0671

Because of the complexity of the State Plan Amendment (SPA) required to enact USS, the implementation of USS was delayed from our original projections. DHS has now received approval from Centers for Medicare and Medicaid Services (CMS). USS standards will go into effect 10/17/22, to give providers time to implement.

• For mental health clinics, CTSS, ACT, ARMHS, and other certified programs, all staff and volunteers who provide direct contact services must have a background study before they provide direct contact services. For these provider types, there are no specific requirements about how often the background studies must occur, the type of background study, or any actions that must be taken regarding the study results. The provider may determine the process for completing background studies and the action to take in response to any criminal history. b. For staff at a CTSS, this may include use of NetStudy 2.0.
• For staff at a CTSS, this may include use of NetStudy 2.0.
• All DHS licensed programs including IRTS/RCS must use NetStudy according to the requirements in chapter 245C for all individuals listed in section 245C.03. For any questions regarding your organization’s use of NetStudy, please contact the Background Studies Division by calling 651-431-6620.

• You must document the date of approval, who gave approval, and the dated signature of the person that obtained the oral approval.
• If the requirement is measured in hours (12 hours, 72 hours, etc.), providers must document the time of approval.

• Level of care assessments are required for specific service lines, usually more intensive services. These are ARMHS, ACT, YACT/IRMHS, ITFC, Adult Day Treatment, IRTS, and Partial Hospitalization.
• Outpatient therapy and CTSS do not require a level of care assessment.
• For clients under 18, the provider should complete the ECSII or CASII as appropriate by age. If a diagnostic assessment (DA) is being done at the same time, the CASII/ECSII does not need to be completed twice; completing it as part of the DA meets the requirement to provide a functional assessment.
• For clients 18 and older, see the Level of Care Assessment section of the Minnesota Health Care Programs Provider Manual for more information.

• Yes. All programs that administer medication will need a policy and procedure for medications and must meet all applicable requirements.
  Some subdivisions will only apply to residential programs. The policies will need to include how the program will provide training for staff who administer medications and how they will perform recordkeeping for medication administration.
• Please note that a prescriber or registered nurse may train other staff to perform the actual administration of medication, but will remain responsible for oversight.

• Vulnerable Adult and Maltreatment of Minors reporting training and other trainings previously required through other statutes and requirements should continue for staff you already employ. Any new annual training refreshers should be scheduled according to the training plan you develop. Programs can choose to base training dates on anniversary of date of hire or have all staff get annual training at the same time.
• Staff who were employed as of the implementation date do not need the orientation training that is due at 90 days.
• DHS will not begin to review compliance with required hours of training (30 hours every two years) until two years after the USS effective date when the trainings are first due.

• A training plan is required at the agency level and must describe how the program evaluates training needs, provides trainings, and evaluates competency. The training plan must describe how the program determines when a staff needs additional training. An annual performance evaluation of a staff person can indicate the staff person’s additional training needs.
• For individual staff, a record of trainings attended must be recorded in the individual’s personnel file.

The initial orientation training should cover the general needs of the clients in your program. As new clients enter services, the program must ensure the staff who are working with them receive additional training to any specific needs not covered in the initial orientation.

Yes. Shadowing a current provider is an acceptable means of training. However, Minnesota Statutes section 245I.05, subdivision 3 requires some trainings to be completed prior to, or within a certain timeframe of having direct contact with clients. 245C.02, sub 11, defines direct contact. Shadowing would be considered direct contact.

The training requirements apply to any person that has direct contact with a program’s clients. Direct contact is defined as providing face-to-face care, training, supervision, counseling, consultation, or medication assistance to persons served by the program. If a staff person does not perform any of these functions, direct contact training is not required.

• No, treatment supervision must be provided by a mental health professional or certified rehabilitation specialist.
• Note that the only specific requirements about how often a professional needs to provide treatment supervision are those for mental health rehabilitation workers and mental health behavioral aides in 245I.06 subd., 3, a monthly requirement for ARMHS, and case reviews in 245I.20, subd. 5.

Yes

A person’s competency upon completion of training should be determined by the person responsible for the training. Examples of competency evaluation may include, but are not limited to: tests, observations, skills demonstration, discussion, or attestation statements.

Yes, the observation is for all rehabilitation workers and is not dependent on which shift they are working. You may set a time for observation at the beginning or end of a shift when clients are more likely to be awake.

DHS will stop using the Qualified Supervisor Form DHS-6330 when USS regulations to into effect. All enrolled professionals will be marked in our records as qualified to supervise, in alignment with the new law. This would allow for a claim for a clinical trainee to be paid out. It will be up to individual professionals to determine when and in what circumstances they are willing to perform treatment supervision.

• The new USS standards no longer use the term “clinical supervision.” Instead, the term “treatment supervision” is used throughout.
• Clinical supervision is a term used by boards of practice in determining a candidate’s advancement to independent practice and licensure. Each board may have different requirements about how much supervision is in person, if interactive video may be used, and which kinds of professionals are allowed to do the supervision. DHS does not control these requirements.
• Treatment supervision is intended to ensure oversight of staff providing treatment services, who are not mental health professionals or certified rehabilitation specialists. The requirements for treatment supervision are in 245I.06. Responsibility for services needs to be tied to a person who is qualified for independent professional practice.

• Phone conversations, video, or in person may be acceptable means to provide supervision.
• Instances of supervision do not have to be documented to meet a certain number of hours.
• For IRTS/RCS only, if a weekly team meeting is used to meet a treatment supervision requirement the mental health professional or certified rehabilitation specialist must be physically present at the meeting.

• Type of service is the service line type being provided (e.g., IRTS, CTSS, ARMHS, etc.).
• Modality and method are interchangeable and both refer to the way in which the treatment is performed (e.g., individual psychotherapy, Group DBT, Skills Training, etc.).
• Intervention is the action that was used during the treatment service (e.g., coaching, teaching, modeling, etc.).

• While there was a lot of variation in how people interpreted the “adult update” DHS did use a significant amount of that language to describe how all DAs for existing clients should be performed. The annual DA can focus on any items that have changed. If very little has changed, it may be an indication that it is time to revise treatment goals or strategies. 
• The information that is “no change” should be accessible and clear, however you choose to incorporate it. Depending on your records’ organization, this might be easier to do by attaching the previous document or by copying portions into the new record.

• Re-engagement is a concept developed with input from stakeholders to avoid situations where an unsigned treatment plan led to a sudden stop of services, particularly for children or youth. DHS hopes that providers serving children are able to perform and bill for services with fewer interruptions, while still placing a high value of parental/guardian engagement, a key predictor of the success of treatment for a child.
• For an adult who may disagree with the goals suggested by the provider but who is still attending appointments, it may be enough to “document in the client file the reasons why the client does not agree with the treatment plan” but continue to work through the plan collaboratively. For persons unable to consent to services on their own, it remains important to establish consent from another source (e.g., parent or guardian).
• A mental health professional is required to lead the effort of re-engagement and to be involved in the process. A trainee or practitioner can reach out under their direction, especially if they have prior trust with the family/guardian.
• Re-engagement as defined in 245I does not alter who can consent to services. See chapter 253B for information on mental health commitments, and chapter 144.341 for more information about minor’s consent to services. This may also include consent via guardianship, children’s protective services, or by other means.
• Services that are otherwise appropriate should continue and may be billed to MHCP programs in the 30 day timeline. Sudden and unplanned discontinuation of treatment should be avoided.
• After the re-engagement period, the provider will once again need to take action if the treatment plan has expired. Some areas a provider should then consider: Is there any other source of legal consent? Do the child’s needs fit into any of the categories where the child can give consent?

Per 245I.02 Subd 16, family and natural supports are as identified by the client. If a client does not identify anyone as falling into that category or indicates they do not want family involvement in their treatment, that should be noted as part of the ITP, fulfilling the requirement to identify the participants in the treatment planning(245I.10 subd 8, paragraph a, item 5.)

Generally, it is not required with the exception that a mental health professional must approve these notes:

• CTSS Day Treatment requires that a supervisor review treatment records every 30 days and sign for the broader record. 256B.0943 Subd 6, Para (b), Item (5).
• When a professional, certified rehab specialist, clinical trainee, or practitioner does direct observation of a behavioral aide or rehab worker, they need to approve the applicable progress note. 245I.06 Subd 3.vioral aide or rehab

• For Medical Assistance services, an SDQ will not be required once the Uniform Service Standards are implemented.
• If you have a separate contract to provide School Linked Behavioral Health (SLBH) services, the SDQ may still be required as part of that contract.
• Users can simply select the “Skip SDQ to CASII” or “Skip SDQ to ECSII” buttons to move past the SDQ data entry page. The User Manual includes instructions (PDF) for skipping SDQ data entry can be found on page 5 under the heading “Completing the Strengths and Difficulties Questionnaire (SDQ).”

Initial training:

• Compare current orientation to new orientation requirements. 
• Provide orientation according to new standards to all new staff hired on or after October 17, 2022. 

Ongoing training:

• Compare current training to new ongoing training requirements. 
• Ensure staff receive required trainings. 
• For existing staff, programs have until the first annual cycle after October 17, 2022, for staff to complete the annual trainings and until two years after October 17, 2022, for staff to complete the every two year trainings. 
• For new staff, hired after October 17, 2022, the annual and every two year trainings are first due annually and two years after hire. 
• Whether these timeframes are set by the staff person's hire date or a specified annual cycle are determined by the program as indicated in the program’s training plan. 
• Programs may provide these trainings more frequently if desired.

A significant focus in the Uniform Service Standards reforms is on how to reduce ways in which clients are repeatedly asked the same or similar questions, because of how this may negatively impact engagement in services. If a person has some correct information compiled, the provider does not need to re-ask those questions just for the sake of asking them. Collateral information, prior assessments, and other outside information can be used to complete a DA.

245I.10 Subd 2, paragraph g gives guidance on this. (g) “For an existing client, the license holder must ensure that a new standard diagnostic assessment includes a written update containing all significant new or changed information about the client, and an update regarding what information has not significantly changed, including a discussion with the client about changes in the client's life situation, functioning, presenting problems, and progress with achieving treatment goals since the client's last diagnostic assessment was completed.”

The statute does not define “existing client” but the intent was to indicate a client who already has an assessment. DHS may seek to clarify this language in a future legislative session. 

If the clinician is making minor changes to a diagnostic assessment and does not see/ meet with the client in order to do so, they should not bill for a diagnostic assessment. A diagnostic assessment requires in person or interactive video visit with the person served. See 245I.10 Subd 6 para (a). 

Example: A client comes to a provider with a diagnostic assessment that does not specify if the diagnosis is SPMI. The diagnostic assessment however, does note frequent prior use of crisis services. The clinician amends the record to include a finding that the client meets SPMI criteria based on crisis team use (245.462, Subd 20, Para (C) item 3), and recommends that TCM services should be offered to the client. The provider does not bill for a diagnostic assessment because they don’t see the client to do this revision. The revision is minor and is very much drawn from existing work already performed.

If the clinician is making more substantive changes, and meets with the person to gather more information, and at the end produces a document that meets the requirements for a diagnostic assessment (some information copied in from prior assessments, some changes, updates and revisions made), they may bill a diagnostic assessment.

Example: A  client presents to a provider with a referral from an emergency room. There is a good workup on present condition/symptomology, but there isn’t detail on developmental/trauma history that could result in a different diagnosis. The provider meets with the client, asks additional questions to flesh out the diagnostic assessment, notes which items need to be deferred and further examined in the course of treatment, and compiles the result. Substantial work has occurred, and there is a final document that contains the required elements of the diagnostic assessment. This provider may bill for a diagnostic assessment.

• For mental health clinics, the new law eliminates the “Multidisciplinary Case Review and Consultation,” the “Peer Review” and the “Internal Utilization Review”
• The law introduces “case review” as a requirement specifically for clinical trainees and practitioners, and the flexible “Quality Assurance and Improvement plan” for the clinic. In summary, DHS believes this is a significant reduction in the administrative burden of certification while still promoting effective services.

Case reviews are identified as part of treatment supervision as required by section 245I.06. The reviews should be completed according to the supervision plan on file for each mental health practitioner or clinical trainee with the identified mental health professional. Each case review must be done by the mental health professional who is assigned as responsible for the client's case according to section 245I.06, subdivision 5, paragraph (a). The supervision plan can include more than one treatment supervisor for each staff person.

• For non-certified clinics (e.g., a clinic that currently does not have a Rule 29 certification from DHS and will not have a 245I.20 certification), the impact of Uniform Service Standards is limited to services delivered to MHCP clients. This is similar to how Rule 47 has applied as a condition of payment.
• When Uniform Service Standards becomes effective, a mental health professional accepting MHCP payment will need to adhere to:

• following provider qualifications and scopes of practice under section 245I.04
• maintaining and updating personnel files under section 245I.07
• documenting under section 245I.08
• maintaining and updating client files under section 245I.09
• completing client assessments and treatment planning under section 245I.10
• providing clients with health services and medications under section 245I.11
• respecting and enforcing client rights under section 245I.12

If a clinic or practice has non-professionals (including clinical trainees), the trainees are required to follow additional standards when working with an MCHP client. This requirement is found at 256B.0671 subd 2, para (b). This includes:

• 245I.03 (Policies and Procedures)
• 245I.05 (Training)
• 245I.06 (Supervision)

Yes. Evaluation/management services should continue to be performed according to national CPT guidance. USS requirements do not apply.