Contracted Case Management Program and ACT Team Intakes from a non-Hennepin
County provider or directly from a client.
1. The Hennepin County Initial Contact & Assessment role for these types of referrals is
to complete an initial screening and then to facilitate the case opening to the Contracted
Case Management and/or ACT Team Provider being noted within the county system. The
purpose of the initial screening will be to verify that the person is the social service and
financial responsibility of Hennepin County, and to also verify that the person is not open
to other case management providers.
2. When the Contracted Case Management and/or ACT Team Provider receives a referral
from a community agency or a client contacts them directly, they should contact the
Hennepin County Initial Contact group by calling 612-348-4111 or sending an email to
socialservices@hennepin.us. The Initial Contact staff will verify eligibility for social
services in Hennepin County
3. During that conversation or email correspondence, the Contracted Case Management
and/or ACT Team Provider will need to verify that the client is not open to other case
management services, county of financial responsibility, health care coverage and
possible PMAP affiliation.
4. You will need to complete the Contracted Case Management and/or ACT Team
Provider Case Opening Form.
5. The Contracted Case Management and/or ACT Team Provider would then send or fax
the Case Opening Form. The form must be complete. The form must now include the:
Date of Diagnosis, Name of SPMI Diagnosis, ICD 9 Code and WHODAS score. The
diagnostic must be current (within the past 6 months). The Information Disclosure NonEpic HSPHD Clients Form must also be completed and signed by the client. Fax the
completed Case Opening Form and the Information Disclosure Non-Epic HSPHD Clients
Form to 612-466-9833, or mail to Office Support staff at Hennepin County, A1400
Government Center, 300 South 6th Street, Minneapolis, MN 55487. Do not send by
email. Please note that the form will no longer be checked by a Social Work Supervisor.
The case cannot be opened in SSIS until the complete form is received. This now
includes the WHODAS Score for all voluntary clients. Each agency is responsible for
having the current diagnostic form and WHOAS assessment available for auditing
purposes.
6. Office Support will enter the information into SSIS. They will contact you if there is
additional information needed. They will then send you an email verifying that the case
was opened along with the SSIS case number. Should you not receive an email within
one week of having submitted a case for assignment to your group you should contact
susan.pirk@.hennepin.us . The email should include the client’s name and the date that
you faxed or mailed the request.
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7. Contracted Case Management providers are expected to comply with and provide
services as directed by Rule 79 Targeted Case Management Guidelines.
8. You will also need to continue to complete and fax the Hennepin County Adult
Behavioral Health Client Authorization form to the Service Authorization Unit at 612632-8681. When clients are open to Medical Assistance with a PMAP the case
management service is paid through the PMAP. You will continue to work with the
PMAP’s on providing information needed for billing for services. You will not submit
this form until after you receive verification of the case opening and the SSIS number.
9. Six month and annual functional assessments do not need to be sent in but, still need
to be completed and kept with the clients file. The "gold form" no longer needs to be
submitted.
Contracted & ACT referrals (request to transfer) from an active Hennepin County BHCM
Team.
The referral should be made directly to the Contracted or ACT provider. Referral information
should be sent directly to the Contracted or ACT provider. When the Contracted or ACT team
has made a decision they should send an email to the referring case manager, copy in Sue Pirk
(at susan.pirk@.hennepin.us) with the decision noting the transfer date. If accepting the client
for services then, send a service authorization to 612 632-8681. Sue Pirk will open the case to
the Contracted or ACT Team, close the BHCM episode, and will send an email to both parties
noting such.
ACT referrals from Service Planners.
Service Planners send available information to ACT teams, but no specific referral package is
required. Referral information in support of the transfer is advised but not required when such
information is not available or pursuit of same would delay referral process to the detriment of
the client. When ACT makes a decision they email the service planner and copy in Sue Pirk (at
susan.pirk@hennepin.us) with the decision noting the transfer date. Please fax the Hennepin
County Behavioral Health Client Authorization form to the Service Authorization Unit at 612632-8681. Sue Pirk will open the case to the ACT team, close the Service Planner case and send
a confirming email to both parties.
Contracted Case Management Referrals from Service Planners.
Service Planners will send current diagnostics and a transfer summary along with any other
supportive documentation to the Contracted agency. When the Contracted Case Management
Team makes a decision they email the service planner and copy in Sue Pirk (at
susan.pirk@hennepin.us) with the decision noting the transfer date. The Contracted Case
Management program will fax the service authorization to 612 632-8681. Sue Pirk will open
case to the Contracted provider, close the Service Planner case and send a confirming email to
both parties.
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Transfers from ACT teams to Contracted Rule 79 BHCM
Remember that a transfer to R79 BHCM Team (Contracted or County) will need to include a
current diagnostic assessment and verification of an SPMI diagnosis. This is particularly
important since you could be serving a client who meets only SMI criteria. You will also need to
include a transfer summary, functional assessment and LOCUS form. When Contracted team
makes a decision they email the ACT Team worker and copy in Sue Pirk (at
susan.pirk@.hennepin.us) with the decision noting the transfer date. Then fax the service
authorization to 612-632-8681. Sue Pirk will open the case to the Contracted team, close the
ACT case and send a confirming email to both parties.
Transfers between Hennepin County Contracted providers:
1. Transfers between Case Management providers do NOT need to be routed through the
front door. Send transfer packet directly to the provider. Once a decision to transfer is
made:
2. Email Sue Pirk at susan.pirk@.hennepin.us
3. Copy the referring case manager
4. Include Client name, HSIS # and/or SSIS#, date of case opening with our program and
name of primary case manager.
Transfers from Contracted Teams to a Hennepin County BHCM Team:
Transfer information should be routed to Rebecca Prust by either fax at 612-466-9833 or
mail. Send an email ahead of time to Rebecca Prust at Rebecca.Prust@hennepin.us and
cc Sue Pirk.
Please note that the information related to transfers is related to clients currently receiving
services with a Hennepin County BH Team, Hennepin County Contracted Team or
Hennepin County ACT Team. Any other referrals will need to be treated as new referrals.
Case Management Assignments from the Initial Contact & Assessment area at Hennepin
County
Cases from Hennepin County Initial Contact & Assessment will also continue to be
assigned to Contracted Case Management Providers. Contact Rebecca Prust if for some
reason you are not able to have your program on the rotation for case assignments each
month. The case rotation log is updated monthly. You will continue to receive an email
from Sue Pirk when cases are assigned to your team. She will also continue to fax you the
information for the case.
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Involuntary Client Transfer Requests.
Any requests to transfer Involuntary/Commitment cases from a Contracted Provider to a
Hennepin County Case Management Team or another Contracted Provider must be
routed through Rebecca Prust.
This would be started by contacting Rebecca by phone at 612-543-0043 or email at
Rebecca.Prust@hennepin.us to discuss the request to transfer.
If it is agreed that this would be in the best interest of the client then the information
related to the transfer should be faxed to 612-466-9833 or mailed to Rebecca.
Information should include the case opening form, a current diagnostic assessment,
functional assessment, transfer summary, prepetition screening report, and court orders.
Any cases going between levels of case management such as Contracted Case
Management to or from an ACT Team need to include a Locus form.
When completing the intake form please leave the open date, program, supervisor and
case manager information blank-that will be completed by Rebecca Prust once the
transfer is approved.
Once the transfer is approved the program requesting the transfer will receive an email
notifying them of the team and supervisor that will be receiving the case transfer.
Case Management Closing Process
Closing information must include the closing summary and Notice of Action Form. Fax
the information to 612-466-9833 or mail the closing information to Sue Pirk. Due to the
high volume of case closings Sue Pirk will not be emailing verifications of closings.
Case Management Re-Opens
Please also be reminded that should a client again request services and/or there is a
petition for commitment within sixty days of closing the case it is assigned to and returns
to your team.
Contract Questions
For questions related to your contract, please contact your Contract Manager.
Mentally Ill and Dangerous Petitions and Commitments
The Forensic Case Management Unit respects the long term working relationship the contracted providers
have had with their clients, but for the purposes of protecting their clients’ legal rights, it is department
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policy that all clients committed as Mentally Ill and Dangerous are transferred to and managed by the
Hennepin County Forensic Case Management Unit.
When a client becomes committed as MID, the laws, the legal system and court processes are quite
different than they are in District Court for the Straight Mental Health commitments. The Forensic Case
Management Unit is a specialized area that is trained to concentrate on the Laws and Mandates Specific
to the MID Commitment, and the Team has Attorney's that are specialized in this area as well.
When a contracted provider has a client with a petition for an MID commitment, that provider should email me directly, and alert me to the petition and the court date. Following the hearing, the provider
should e-mail me with the outcome in court.
Here is my contact information:
Paul Lussenhop, Forensic Case Management Unit Supervisor
e-mail: Paul.Lussenhop@hennepin.us
Phone: 612-490-3584
Fax: 612-677-6308
Address: A-1400 Hennepin County Government Center
300 South 6th Street
Minneapolis MN 55487
Mail Code: 140
If a client is committed as MID at the initial hearing, the case should be transferred directly to me for
assignment within the Forensic Case Management Unit.
This should happen right at the point of initial support for the MID commitment when the client is on the
warrant. The provider should not wait until the commitment has been finalized.
This again is for the purpose of protecting the client's legal rights, and preparing them for the
commitment and treatment process under this unique commitment.
If by chance the MID commitment is not supported at the end of the Warrant, I will transfer the case back
to the provider for ongoing case management services.
When the provider notifies me that their client has been supported for an MID commitment, these are the
items I will need for case transfer:
1) The commitment order
2) The ENTIRE file. If the provider's file is electronic, and not linked to our system, then I will need a
copy of their entire file.
3) A transfer summary, to include most recent diagnoses, as well as the precipitating incident leading up
to the MID commitment
4) I do not need an updated ICSP or Functional Assessment, as we will do our own once we've met and
assessed the client.
I will make sure that for the purpose of continuity of services, I will close their case in the systems on the
same date that I open the case in Forensic Case Management.
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