CurrentUCarePolicy N/A

Coordination with members receiving Behavioral Health Home (BHH) services.

Defines expectations for UCare Care Coordinators and MCO/delegate interactions with members receiving Behavioral Health Home services in Minnesota; governs care coordination, referrals, notifications, and duplication rules for affected members and providers.

Policy Summary

PayerUCare

PolicyCoordination with members receiving Behavioral Health Home (BHH) services.

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionBHH providers must determine eligibility via diagnostic assessment and fax Notification of Eligibility (DHS-4797) to UCare within 30 days of intake.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30 daysFax Notification of Eligibility (DHS-4797)

30 business daysCC contact after notification

same calendar monthMutually exclusive services timeframe

listDuplicative services list

Coverage Criteria

(untitled)

BHH referrals, eligibility determination, notification, and coordination requirements

ALL of the following

BHH services are available to adults receiving Medical Assistance with mental illness, including serious and persistent mental illness, substance use disorder, and severe emotional disturbance. A member who needs additional coordination around behavioral health that meets BHH criteria may be referred to a BHH provider.
Source: BHH referrals
Certified BHH providers will determine eligibility by conducting a diagnostic assessment (DA) or reviewing a previously completed DA. Upon determination of eligibility, the BHH provider must fax the completed Notification of Eligibility for BHH Services (DHS-4797) to UCare within 30 days.
Includes required form DHS-4797 and 30-day reporting timeline
Care Coordinator (CC) or members may call certified BHH providers to schedule a diagnostic assessment.

Policy Summary

PayerUCare

PolicyCoordination with members receiving Behavioral Health Home (BHH) services.

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionBHH providers must determine eligibility via diagnostic assessment and fax Notification of Eligibility (DHS-4797) to UCare within 30 days of intake.

SourceLink

On This Page

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Care Coordinator Collaborative Process

When UCare is notified that a member is working with a BHH, UCare will notify the assigned delegate of the BHH start date, provider, and BHH contact information via secure fax/secure email to the contact information from the Care Coordination Contact List.
UCare notification to delegates
CCs must contact the BHH provider within 30 business days of receiving notification that the member is receiving BHH to share CC contact information, relevant support plan information, establish contact frequency and preferred methods of communication. CCs must include BHH service on the member's support plan and ICT and document all contacts with BHH staff in the member's record.
CC duties and documentation
BHH staff and CCs must work collaboratively to coordinate services and avoid duplication; communications should clarify activities supported by the BHH.
Coordination and duplication avoidance
CCs must notify the member's BHH provider in a timely manner of any known Emergency Room visits, hospital admissions, discharges, or other transitions of care and share post-discharge plans.
ER/Hospital/transition notifications
BHH providers are required to notify the MCO when a member is no longer receiving BHH services; UCare will share this information with delegate agencies via secure fax.
Termination notification

Contact and documentation requirements

Starting BHH services: The BHH provider must send a copy of the DHS-4797 to the MCO within 30 days of intake. UCare will notify delegates and fax/email a copy of the DHS-4797 to the assigned delegate agency; for internally managed members, the assigned CC will be notified through the documentation system.
Intake notification workflow
Assessment, support plan, and monitoring: If the individual has an assigned case manager or care coordinator, the BHH team must record the case manager/CC name and contact information in the person's BHH record and document the schedule for how frequently the BHH team will check in with the CM/CC. CCs must record the BHH name and contact information on the member's support plan, document frequency of contact, and document contacts with BHH providers as they normally would.
Recordkeeping and contact schedule
Emergency Room visits, hospitalizations, and transitions of care: BHH providers must alert UCare or the individual's CC (if known) of any ER admissions, hospital admissions and/or discharges, and contact the member after discharge to ensure access to needed services. CCs must alert the BHH of known ER admissions, hospital admissions and/or discharges and notify BHH of transitions of care and post-discharge/follow-up plans.
Operational responsibilities for acute events and transitions

Coding and Mutually Exclusive Services

BHH service modelmixed

No codes listed

Mutually exclusive monthly services — billing restriction

Mutually exclusive monthly servicesMembers cannot receive BHH and any of the following services in the same calendar month: Mental Health Targeted Case Management (MH-TCM); Assertive Community Treatment (ACT) or Youth ACT; Relocation service coordination targeted case management (RSC-TCM); Vulnerable adult/developmental disability targeted case management (VA/DD-TCM); Health Care Home care coordination.

Choice requirementA person who meets eligibility for one or more of these covered services must choose the single service that best meets their needs.

Payment prohibitionMedicaid payment is prohibited for duplicative services provided in the same calendar month.

Notification, Eligibility, and Duplication Rules for Providers

Prior Authorization

Fax DHS-4797 to UCare within 30 days after eligibility determination

Determine member eligibility by conducting a diagnostic assessment (DA) or reviewing a prior DA. If the member is eligible for BHH services, fax the completed Notification of Eligibility for BHH Services (DHS-4797) to UCare within 30 days of intake. UCare will notify assigned delegate agencies or internal care coordinators of the BHH start date and provider.

Eligibility must be determined via a DA or review of a previous DA.
Fax the completed DHS-4797 Notification of Eligibility to UCare within 30 days of intake.
UCare will notify delegates or assigned CCs of the BHH start date and provider contact information.

Denial Risk

Do not bill BHH with other mutually exclusive monthly services

Medicaid payment is prohibited for duplicative services; a member may not receive BHH and any listed targeted case management or similar service in the same calendar month and must choose the service that best meets their needs.

Prohibited concurrent services in the same calendar month: Mental Health TCM, ACT or Youth ACT, RSC-TCM, VA/DD-TCM, and Health Care Home care coordination.
Member must select which covered service best meets their needs when eligible for more than one.

OpenPayer

Coordination with members receiving Behavioral Health Home (BHH) services.

Coverage Criteria

Coding and Mutually Exclusive Services

Notification, Eligibility, and Duplication Rules for Providers

Definitions