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CTSS Children’s Day Treatment

Revised: April 3, 2023

Overview

Children’s Day Treatment for children’s therapeutic services and supports (CTSS) is a site-based, structured mental health treatment program. It consists of individual or group psychotherapy for two or more individuals, and individual or group skills training provided by a team, under the treatment supervision of a mental health professional. A children’s day treatment program must provide staffing and facilities to ensure the member’s health, safety, and protection of rights, and that the programs are able to implement each member’s individual treatment plan.

The goals of Day Treatment services are to:

Stabilize the child’s mental health status

Develop and improve the child’s independent living and socialization skills

Reduce or relieve the effects of mental illness

Provide training to enable the child to live in the community

Are not part of inpatient or residential treatment services

Eligible Providers

Entity Certification

Children’s and adult day treatment services have different certifications, standards and limitations.

Certified entities include:

Licensed outpatient hospitals with JCAHO accreditation

MHCP-enrolled community mental health centers

County–operated entity certified by the state; or

A noncounty entity certified by the state

IHS or 638 facilities

Children’s day treatment providers, including school districts, must submit an application and receive certification under

CTSS

Programs must provide adequate staffing and facilities to do the following:

Promote member health

Ensure a safe environment

Protect member rights

Provide service delivery to implement each member’s individual treatment plan (ITP)

Treatment Supervision

For children’s day treatment programs, the treatment supervisor must do the following:

Be a licensed and MHCP-enrolled mental health professional

With the staff person supervised by the treatment supervisor, develop a written treatment supervision plan and implement a new staff person’s treatment supervision plan within 30 days of employment, and review and update each staff person’s treatment supervision plan annually.

Focus supervision on each member’s treatment needs and the ability of the staff person under treatment supervision to provide services to each client, according to

Minnesota Statutes 245I.06

, subdivision 1(b), including these topics:

review and evaluation of the interventions that staff delivers to each client

instruction on alternative strategies if a member is not achieving treatment goals

a review and evaluation of each member’s assessments, treatment plans, and progress notes for accuracy and appropriateness

instruction on the cultural norms or values of the clients and communities that the license holder serves and the impact that a member’s culture has on providing treatment

evaluation of and feedback regarding a direct-service staff areas of competency, and

coaching, teaching, and practicing skills with staff.

Approve and sign the member’s diagnosis, ITP and any change to either

Be available for urgent consultation as required by the member’s needs or situation

Treatment supervision must be provided according to Minnesota Statutes, Section 245I.06.

Eligible CTSS Children’s Day Treatment Providers

The following are eligible to provide CTSS Children’s Day Treatment services.

Eligible Members

Eligible members for CTSS Children’s Day Treatment must meet the following:

Be under age 18 and diagnosed with an emotional disturbance (

) or meet severe emotional disturbance (

SED

) criteria

Be between ages 18 and 21 and diagnosed with a mental illness (

) or meet serious and persistent mental illness (

SPMI

) criteria

Need the intensity level of day treatment as identified in the

diagnostic assessment

Be eligible for up to five days of day treatment based on a hospital’s medical history and presentation examination of the member according to

Minnesota Statute 256B.0943, subdivision 3(b)

Members admitted to children’s day treatment must be in need of and have the capacity to understand and benefit from the rehabilitative nature, structured setting and therapeutic components of the program’s psychotherapy and skills activities. Members who do not have, or cease to have, the cognitive capacity to benefit from day treatment services, may benefit from day habilitation or other services under a waiver program. Refer members in need of other services to the county human service agency, school or private agencies.

Members enrolled in a managed care organization must receive day treatment services through the managed care organization, which may have different coverage and authorization requirements. Managed care limits cannot be more restrictive than fee for service.

Covered Services

Day treatment is distinguished from day care by the structured therapeutic program that uses CTSS service components. The Day Treatment program includes:

Skills training – individual or group, provided by a mental health professional, clinical trainee, or mental health practitioner

The program must be available year-round at least three to five days per week, two or three hours per day, unless the normal five-day school week is shortened by a holiday, weather-related cancellation, or other districtwide reduction in a school week. A child transitioning into or out of day treatment must receive a minimum treatment of one day a week for a two-hour time block. The two-hour time block must include at least one hour of patient or family or group psychotherapy. The remainder of the structured treatment program may include patient or family or group psychotherapy, and individual or group skills training, if included in the client’s individual treatment plan.

Minimum group size for day treatment is two individuals. When a day treatment group that meets the minimum group size requirement temporarily falls below the minimum group size because of a member’s temporary absence, including absence due to a declared public emergency, medical assistance covers a group session conducted for the group members in attendance.

The day treatment program must be available as described in the member’s ITP.

Interactive children’s day treatment may use physical aids and nonverbal communication to overcome communication barriers because the member demonstrates one of the following:

Has lost or has not yet developed either the expressive language communication skills to explain his or her symptoms and response to treatment

Does not possess the receptive communication skills needed to understand the mental health professional if he or she were to use adult language for communication

Needs an interpreter, whether due to hearing impairment or because the member’s language is not the same as the provider’s language

Coordination of Services

Providers are responsible to ask MHCP members if they are currently receiving the same health care services from another provider. If the member is receiving the same services from another provider, the providers must coordinate the services and document in the member’s record how the services were coordinated. MHCP will not inform providers of services the member is receiving from other providers.

Documentation Standards

A children’s day treatment provider must ensure that all documentation required by Minnesota Statutes 245I.08:

is legible

identifies the applicable client and staff on each page; and

is signed and dated by the staff persons who provided services to the client or completed the documentation, including staff credentials.

Documenting approval

All diagnostic assessments, functional assessments, level of care assessments, and treatment plans completed by a clinical trainee or mental health practitioner must contain documentation of approval by a treatment supervisor within five business days of initial completion by the staff person under treatment supervision, according to Minnesota Statutes 245I.08, subdivision 2.

Progress notes

A children’s day treatment provider must use a progress note to document each occurrence of a mental health service that a staff person provides to a client, according to Minnesota Statutes 245I.08, subdivision 3. A progress note must include the following:

the type of service;

the date of service;

the start and stop time of the service;

the location of the service;

the scope of the service, including:

the targeted goal and objective;

the intervention that the staff person provided to the client and the methods that the staff person used;

the client’s response to the intervention;

the staff person’s plan to take future actions, including changes in treatment that the staff person will implement if the intervention was ineffective; and

the service modality;

the signature and credentials of the staff person who provided the service to the client;

the mental health provider travel documentation required by

Minnesota Statutes

256B.0625

, if applicable; and

significant observations by the staff person, if applicable, including:

the client’s current risk factors;

emergency interventions by staff;

consultations with or referrals to other professionals, family, or significant others; and

changes in the member’s mental or physical symptoms.

Noncovered Services

CTSS children’s day treatment services cannot be provided at the same time as the following services:

Do not bill the following services as CTSS children’s day treatment:

Mental health behavioral aide (MHBA) services. MHBAs are not an eligible provider of CTSS Day Treatment services.

Service components of CTSS simultaneously provided by more than one provider unless prior authorization is obtained

Treatment by multiple providers within the same agency at the same clock time

Children’s therapeutic services and supports provided in violation of Medical Assistance policy in Minnesota Rules (part

9505.0220

)

Mental health behavioral aide services provided by a personal care assistant who is not qualified as a mental health behavioral aide and employed by a certified children’s therapeutic services and supports provider

Service components of CTSS that are the responsibility of a residential or program license holder, including foster care providers under the terms of a service agreement or administrative rules governing licensure

For children or adolescents with co-occurring substance use disorders, CTSS services should be directed to restore a child or adolescent to an age-appropriate developmental trajectory that had been disrupted by a psychiatric illness. The child or adolescent may require additional services, covered outside of CTSS, to address the substance use disorder.

Additional activities that may be offered by a provider but are not otherwise covered by Medical Assistance, including:

A service that is primarily recreation oriented or that a provider performs in a setting without medical supervision. This includes sports activities, exercise groups, activities such as craft hours, leisure time, social hours, meal or snack time, trips to community activities and tours

A social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client’s emotional disturbance

Prevention or education programs provided to the community

Authorization

Refer to Authorization for general authorization policy and procedures. For CTSS day treatment services, authorization is required in the following situations:

To exceed 150 hours per calendar year (separate from CTSS 200-hour limit)

When there is a need to provide day treatment services concurrent with other services

Billing

Bill children’s day treatment services online using

MN–ITS 837P

Enter the rendering provider NPI number on each claim line

Use procedure code H2012

Use modifier HK to indicate children’s day treatment

Use modifier UA to indicate CTSS

CTSS Children’s Day Treatment

Code

Modifier

Description

Unit

Limitations

H2012

UA
HK

Behavioral Health Day Treatment

1 hour

Daily limit – minimum 2 hours, maximum 3 hours (may not obtain authorization for more day treatment hours in a day)

Weekly limit – maximum 15 hours per week (may not obtain authorization for more day treatment hours in a week)

Calendar year threshold – maximum 150 hours per calendar year without authorization

H2012

UA
HK
U6

Behavioral Health Day Treatment (interactive)

1 hour

Daily limit – minimum 2 hours, maximum 3 hours (may not obtain authorization for more day treatment hours in a day)

Weekly limit – maximum 15 hours per week (may not obtain authorization for more day treatment hours in a week)

Calendar year threshold – maximum 150 hours per calendar year without authorization

Legal References

Minnesota Statutes 256B.0943 CTSS
Minnesota Statutes 245I Mental Health Uniform Service Standards Act

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