October 22, 2012
Dear Provider:
In reviewing cases to determine eligibility for Mental Health Targeted Case Management (MH-TCM)
services, South Country Health Alliance (SCHA) has noticed that some diagnostic assessments have not
been meeting the requirements specified in Minnesota statute and rule. In order to determine eligibility
for Mental Health Targeted Case Management services, an extended or standard diagnostic assessment
needs to be conducted. A recipient must meet criteria for serious and persistent mental illness (SPMI)
for adults or severe emotional disturbance (SED) for children to meet criteria for Mental Health Targeted
Case Management. A new standard or extended diagnostic assessment must also be completed at least
every three years following the initial diagnostic assessment for individuals receiving Mental Health
Targeted Case Management Services to determine a recipient has continued eligibility for Mental Health
Targeted Case Management services.
Therefore, SCHA is providing the following information outlining requirements pertaining to diagnostic
assessments. In addition, SCHA is taking this opportunity to highlight areas where diagnostic
assessments have been lacking information and areas that need improvement in order for providers to
continue to receive payments for these diagnostic assessments.
Diagnostic Assessments:
A diagnostic assessment is a written report that documents clinical and functional face-to-face
evaluation of a recipient’s mental health, including the nature, severity and impact of behavioral
difficulties, functional impairment, and subjective distress of the recipient, and identifies the recipient’s
strengths and resources. A diagnostic assessment is necessary to determine a recipient’s eligibility for
mental health services.
These requirements are specified in statute, rule and in the Minnesota Health Care Programs Manual
(MHCP). See Minnesota Statutes: M.S. 245.462, M.S. 245.4871, and Minnesota Rules: M.R. 9505.0322,
9505.0370, 9505.0371, 9505.0372 and in the Minnesota Health Care Programs Manual (MHCP) which
can be accessed via these links:
2300 Park Drive, Suite 100
Owatonna, MN 55050
Toll Free: 866-567-7242; P: 507-444-7770; F: 507-444-7774 www.mnscha.org
687318864
Page 1
Statute:
https://www.revisor.mn.gov/statutes/?id=245.4871
https://www.revisor.mn.gov/statutes/?id=245.462
Rule:
https://www.revisor.mn.gov/rules/?id=9505.0322
https://www.revisor.mn.gov/rules/?id=9505.0370
https://www.revisor.mn.gov/rules/?id=9505.0371
https://www.revisor.mn.gov/rules/?id=9505.0372
MHCP:
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelection
Method=LatestReleased&dDocName=id_058048
Diagnostic Assessments Eligible for Payment:
 To be eligible for payment, a diagnostic assessment must:
o Meet the conditions of the selected diagnostic assessment type (see below)
o Identify a mental health diagnosis and recommended mental health services which are
the factual basis to develop the recipient’s mental health services and treatment plan;
or include a finding that the recipient does not meet the criteria for a mental health
disorder.
o Be a face-to-face interview with the recipient and a written evaluation. [M.R.
9505.0322]
 To be eligible for medical assistance payment, the diagnostic assessment required for a
determination of a recipient's eligibility to receive mental health case management services
must comply with the requirements of Minnesota Rule, parts 9505.0370 to 9505.0372.
Additionally, the diagnostic assessment must identify the needs that must be addressed in the
recipient's individual treatment plan if the recipient is determined to have a serious and
persistent mental illness or a severe emotional disturbance. [M.R. 9505.0322]
 There are four types of diagnostic assessments when they are provided in accordance with the
requirements as explained in each type. [M.R.9505.0371, subp. 2 and 9505.0372, subp. 1]
 The four types of diagnostic assessments are:
o Brief Diagnostic Assessment (Note: A brief diagnostic assessment cannot be used to
determine eligibility for MH-TCM services.)
o Standard Diagnostic Assessment
o Extended Diagnostic Assessment
o Adult Diagnostic Assessment Update (Note: An adult DA update cannot be used to
determine initial eligibility for MH-TCM or at three years when determining continued
eligibility for MH-TCM)
 In addition, the Diagnostic Assessment Report components (M.R. 9505.0372, subpart 1 items AE) are summarized in the attached document:
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_FILE&RevisionSelectionMethod=Late
SCHA: 687318864
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stReleased&Rendition=Primary&allowInterrupt=1&noSaveAs=1&dDocName=dhs16_163297
Eligibility for Mental Health Targeted Case Management:
SCHA requires prior authorization for MH-TCM. In determining whether someone is eligible to receive
MH-TCM services, the determination must be based on a diagnostic assessment of the person and the
person must have a diagnosis of either Serious and Persistent Mental Illness (SPMI) if an adult; or Severe
Emotional Disturbance (SED) if a child under age 18 years.
For the purposes of case management and community support services, a “person with serious and
persistent mental illness” means an adult who has a mental illness and meets at least one of the
following criteria [M.S. 245.462, subd. 20]:
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:
i.
has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline
personality disorder;
ii.
indicates a significant impairment in functioning; and
iii.
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;
5. the adult has, in the last three years, been committed by a court as a person who is mentally ill
under chapter 253B, or the adult’s commitment has been stayed or continued; or
6. the adult: (i) was eligible under clauses (1) to (5), but the specified time period has expired or the
adult was eligible as a child under section 245.4871, subd. 6; and (ii) 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.
For purposes of eligibility for case management and family community support services “child with
severe emotional disturbance” means a child who has an emotional disturbance and who meets one of
the following criteria [M.S. 245.4871, subd. 6]:
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 an emotional disturbance; or
2. the child is a Minnesota resident and is receiving inpatient treatment or residential treatment for an
emotional disturbance through the interstate compact; or
3. the child has one of the following as determined by a mental health professional:
i.
psychosis or a clinical depression; or
ii.
risk of harming self or others as a result of an emotional disturbance; or
iii.
psychopathological symptoms as a result of being a victim of physical or sexual abuse or
of psychic trauma within the past year; or
4. the child, as a result of an emotional disturbance, 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.
SCHA: 687318864
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Continued Eligibility for MH-TCM:
A recipient’s continued eligibility for MH-TCM must be determined every 36 months. The determination
of whether the recipient continues to have a diagnosis of SPMI or SED must be based on updating the
recipient’s diagnostic assessment or on the results of conducting a complete diagnostic assessment
because the recipient’s mental health status or behavior has changed markedly. Unless a recipient’s
mental health status or behavior has changed markedly since the recipient’s most recent diagnostic
assessment, only updating is necessary. If the recipient’s mental health status or behavior has changed
markedly, a new diagnostic assessment must be completed. [M.R. 9505.0322, subp. 5]
Examples of lack information noted in Diagnostic Assessments
Adults with SPMI (M.S. 245.462, subd. 20)
For the purposes of case management and community support services, a “person with serious
and persistent mental illness” means an adult who has a mental illness and meets at least one of
the following criteria:
Statute provision
What is lacking in Diagnostic Assessment
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:
i.
Has a diagnosis of schizophrenia,
bipolar disorder, major
depression, or borderline
personality disorder;
ii.
Indicates a significant impairment
in functioning; and
iii.
Has a written opinion from a
mental health professional, in the
last three years, stating that the
SCHA: 687318864




No dates provided for inpatient care
DA states “see previous record” – nothing
attached or explained
No reference to psychiatric hospitalization
dates
Confusing adult foster homes as being
residential treatment and basing eligibility
on living in adult foster home
May have had previous psychiatric
hospitalization or residential treatment
but it did not exceed 6 months duration
and did not occur within the preceding 12
months
States “see previous record” and nothing
attached and nothing is explained
States was treated by a crisis team but
doesn’t specify dates or timeframes or
identify the crisis service provider
States “see previous record” and nothing
attached and nothing is explained
Lacks narrative description for items
contained in the diagnostic assessment
May have diagnosis but no information
provided on significant impairment of
functioning
Often times use symptom checklist with
no narrative provided
Medications not listed or medications
listed aren’t common treatment course for
diagnosis listed
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adult is reasonable 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;



No information as to current mental
health symptoms or how symptoms have
changed if an adult DA Update was done
No impact on how diagnosis is impacting
ability to function
No written opinion listed outlining why
likely to future episodes requiring
inpatient or residential treatment or only
checkbox marked indicating this but no
explanation provided
5. The adult has, in the last three years, been  If committed, no dates are specified
committed by a court as a person who is
 Sometimes was committed under CD and
mentally ill under chapter 253B, or the
not MH
adult’s commitment has been stayed or
continued; or
6. The adult: (i) was eligible under clauses (1)  No written opinion listed outlining why
to (5), but the specified time period has
likely to future episodes requiring
expired or the adult was eligible as a child
inpatient or residential treatment or only
under section 245.4871, subd. 6; and (ii)
checkbox marked indicating this but no
has a written opinion from a mental health
explanation provided
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.
Children (M.S. 245.4871, subd. 6):
For purposes of eligibility for case management and family community support services “child
with severe emotional disturbance” means a child who has an emotional disturbance and who
meets one of the following criteria:
Statute provision
What is lacking in Diagnostic Assessment
1. The child has been admitted within the
last three years or is at risk of being
admitted to inpatient treatment or
residential treatment of an emotional
disturbance; or
2. The child is a Minnesota resident and is
receiving inpatient treatment or
residential treatment for an emotional
disturbance through the interstate
compact; or
3. The child; has one of the following as
determined by a mental health
SCHA: 687318864

States previous inpatient treatment or
residential treatment but no
dates/timeframes or facility specified

May list diagnosis but no narrative to
support diagnosis given
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professional:
i.
Psychosis or a clinical depression;
or
ii.
Risk of harming self or others as a
result of an emotional
disturbance; or
iii.
Psychopathological symptoms as a
result of being a victim of physical
or sexual abuse or of psychic
trauma within the past year; or
4. The child, as a result of an emotional
disturbance, 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.




May list risk of harming self/others but no
explanation provided
May list person was a victim but no
information provided
Lists diagnosis but does not provide
information to show significant
impairments in functioning
No written opinion listed or only checkbox
provided with no narrative to provide
support for opinion
If you would like further training on completing Diagnostic Assessments, the Minnesota Department of
Human Services offers webinar training. The training segments can be found at the following links:
http://pathlore.dhs.state.mn.us/stc/amh/psciis.dll?mainmenu=amh (training pertaining to diagnostic
assessments)
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelection
Method=LatestReleased&dDocName=Training (this link shows you how to register for training events)
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelection
Method=LatestReleased&dDocName=dhs16_160315 (this link has DA PowerPoint documents for DA
training)
If you have questions regarding this information, please contact either:
Joan Monahan
Mental Health & Chemical Health Manager
Direct line: 507-431-6369
Fax: 507-431-6329
Email: jmonahan@mnscha.org
or
Mary Schwieters
Chemical Health and Mental Health Coordinator
Direct line: 507-431-6377
Fax: 507-431-6329
Email: mschwieters@mnscha.org
Sincerely,
South Country Health Alliance
SCHA: 687318864
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