Adult Rehabilitative Mental Health Services (ARMHS)

Adult Rehabilitative Mental Health Services (ARMHS)

Adult rehabilitative mental health services (ARMHS) are mental health services that are rehabilitative and enable the member to develop and enhance psychiatric stability, social competencies, personal and emotional adjustment, and independent living and community skills when these abilities are impaired by the symptoms of mental illness. The services also enable a member to retain stability and functioning if he or she is at risk of losing significant functionality or being admitted to a more restrictive service setting without these services. The services instruct, assist and support a member in areas such as medication education and monitoring, and basic social and living skills in mental illness symptom management, household management and employment-related or community living transitions.

Eligible Providers

Each ARMHS provider entity must be certified to provide ARMHS. Certification ensures that the provider is capable of providing directly, or contracting for, the full array of ARMHS.

Non-county entities must receive additional certification from each county in which they provide services. The additional certification must be based on the entity’s knowledge of the county’s local health and human services system, and the ability of the entity to coordinate its services with other services available in that county.

County-operated entities must receive additional certification from any other counties in which they will provide services.

ARMHS entities must be recertified every three years.

The following individual mental health providers are eligible to provide ARMHS:

* Mental health rehabilitation workers cannot develop a FA, LOCUS, interpretive summary or individual treatment plan (ITP). The MHRW can implement ITP interventions and develop a progress note co-signed by the clinical supervisor or treatment director.

The following providers are eligible to provide medication education services under ARMHS:

  • Physician
  • Registered nurse
  • Physician assistant
  • Pharmacist

Eligible Recipients

To be eligible for ARMHS, MHCP members must meet all of the following criteria:

  • Be 18 years old or older
  • Have a primary diagnosis of a serious mental illness as determined by a Diagnostic Assessment
  • Have a completed LOCUS assessment that indicates a Level 3 or Level 2
  • Have a significant impairment in functioning in three or more areas of the Functional Assessment domains specified in statute

Covered Services

The following seven services are billable as ARMHS:

  • Basic living and social skills
  • Certified peer specialist services
  • Community intervention
  • Functional assessment
  • Individual treatment plan
  • Medication education
  • Transition to community living services

All covered services are provided face-to-face except community intervention. Documentation of activities is included in the covered service and must not be billed separately.

ARMHS services may be provided in the following settings:

  • A member’s home
  • The home of a relative or significant other
  • A member’s job site
  • The community, such as any of the following:
  • Psychosocial clubhouse
  • Drop-in center
  • Social setting
  • Classroom
  • Other place in the community

Do not provide ARMHS, except for services that meet the requirements under Transition to Community Living Services, to a member residing in any of the following:

  • Regional treatment centers
  • Nursing facilities
  • Acute-care settings (inpatient hospital)
  • Sub-acute settings (Intensive Residential Treatment Services [IRTS] program)

Basic Living and Social Skills

Basic living and social skills are activities that instruct, assist and support a member in skill areas essential for every day, independent living. Examples of skill areas include the following:

  • Interpersonal communications
  • Community resource utilization and integration
  • Crisis assistance
  • Relapse prevention
  • Budgeting, shopping and healthy lifestyle skills and practices
  • Cooking and nutrition
  • Transportation
  • Medication monitoring
  • Mental illness symptom management
  • Household management
  • Employment-related skills
  • Transitioning to community living

Each member’s treatment plan should identify specific skills needed, how each is being addressed, the method (individually, group), and the medical necessity for each goal.

Provide basic living and social skills individually or in a group setting, when appropriate, to each participating member’s needs and treatment plan. A basic living and social skills group is two to 10 people, at least one of whom is an MA member. Up to two staff people may bill MHCP for services provided to a group. Each staff person must bill for different members.

Provide basic living and social skills directly (face-to-face) to the member. Do not bill if the contact is conducted by telephone.

Certified Peer Specialist Services

CPS services include the following:

  • Non-clinical, recovery-focused activities encouraging empowerment, self-determination, and decision-making, which are only provided by a CPS
  • Activities that can address and contribute to the ARMHS team insights about feelings associated with stigma, social isolation, personal loss, systemic power dynamics and restoring one’s lifestyle following hospitalization, or other acute care services

A CPS Level I cannot develop the Functional Assessment, Interpretive Summary (IS), LOCUS and the ITP. A co-signature is not needed on the progress note.

Refer to the Certified Peer Specialist Services section of this manual for more information.

Community Intervention

Community intervention is a service of strategies provided on behalf of a member to do the following:

  • Alleviate or reduce a member’s barriers to community integration or independent living
  • Minimize the risk of hospitalization or placement in a more restrictive living arrangement

Community intervention may be conducted with an agency, institution, employer, landlord or member’s family and may require the involvement of the member’s relatives, guardians, friends, employer, landlord, treatment providers or other significant people to change situations and allow the member to function more independently.

Delivery of community intervention services meets the following:

  • Must be directed exclusively to the treatment of the member
  • Must be provided on an individual basis only (cannot be provided in a group)
  • May be conducted in person or by telephone if the intervention strategy warrants it (document accordingly)
  • May be conducted without the member present when the intervention strategy warrants it (document why the strategy is more effective without the member present)

Do not bill community intervention for the following reasons:

  • Routine communication between members of a treatment team, a routine staffing or a care conference
  • Telephone contacts that do not conform to the definition of this service or that are not properly documented
  • Clinical supervision or consultation with other professionals
  • Treatment plan development

Functional Assessment (FA)

The billable service of an FA includes the functional and LOCUS assessments, and the interpretive summary. A comprehensive FA is a narrative that describes how the person’s mental health symptoms impact their day-to-day functioning in a variety of roles and settings. It is important to look at how factors other than mental health symptoms impact life functioning.

Refer to Functional Assessments in this manual for complete information.

LOCUS

Assessment of functional ability informs the level of care utilization system (LOCUS) assessment, which determines the service intensity needs of the individual. Refer to the LOCUS section of this manual for more information.

Interpretive Summary

The interpretive summary is used to synthesize the information obtained from the three-tier assessment process (diagnostic, functional and LOCUS) to prioritize direction for the upcoming individual treatment plan. It is an essential bridge or link from assessment to service planning.

An interpretive summary does the following:

  • Identifies what outcomes the person desires relative to his or her life circumstances and preferences
  • Describes how the mental health symptoms are affecting the person’s and his or her family’s life
  • Summarizes the nature of the functional barriers as they relate to symptoms of the mental illness to establish the priorities for the next treatment plan
  • Examines the person’s strengths, abilities and resources
  • Examines how the person’s strengths, abilities and resources can be engaged to improve functioning and move forward on identified desirable recovery outcomes
  • Establishes the priorities for the initial and subsequent individual treatment plan
  • Recommends services and interventions

The mental health clinical supervisor or mental health practitioners under the supervision of the mental health professional clinical supervisor must complete the interpretive summary. The mental health professional and mental health practitioner must sign the interpretive summary.

Individual Treatment Plan (ITP)

An individual treatment plan (ITP) is a written plan that documents the treatment strategy, the schedule for accomplishing the goals and objectives, and the responsible party for each treatment component. Complete an individual treatment plan before mental health service delivery begins.

An ITP of any ARMHS is based on a diagnostic and functional assessment, documents the plan of care and guides treatment interventions. Development of the ITP includes involvement of the client, client’s family, caregivers or other people, which may include people authorized to consent to mental health services for the client, and includes arrangement of treatment and support activities consistent with the client’s cultural and linguistic needs.

The ITP focuses on the person’s vision of recovery, his or her priority treatment goals and objectives, and the interventions that will help meet those goals and objectives. The plan must be written in a way in which the person and his or her family have a clear understanding of the services being offered and specifically how the services will address their concerns. The person must take part in the process of developing the ITP to make sure the treatment is relevant to the priorities and incorporates his or her strengths.

When completing the ITP for adults, the following components must be present on the plan:

  • Cultural considerations, as related to service plan and delivery
  • A list of functional barriers to be addressed in the plan
  • Strength and resources that are a benefit in this time of change
  • Referrals to be pursued, if any
  • Information about service coordination that identifies the following:
  • Other service providers
  • The service
  • Frequency and form of routine contact between ARMHS and other providers
  • Documentation of progress (or lack thereof) as a written review that evaluates progress toward goals and objectives from the previous plan
  • Signature and date line for the member or legal guardian and ARMHS provider

Give a copy of the approved plan to the member or guardian.

If a person refuses to sign the plan, document efforts to engage the person in his or her treatment plan and why he or she was not willing to sign the plan.

Additional requirements for the ITP include the following:

  • Recovery vision: Reflects the person’s aspirations regarding his or her life stated in his or her own words.
  • Goal (Rehab): A target for change that is achievable within nine months to three years. A goal describes a target for change that will result in achieving a desired outcome. The recommendation is no more than two rehabilitative goals within a plan.
  • Objectives: Achievable within six months or less. A small positive forward step describing what the person will be able to do or the result to be realized. The ITP outlines the small steps the person will take. The recommendation is no more than three objectives that can be targeted sequentially or concurrently to attain the goal. Objectives are measurable and observable with an identified baseline and target measure.
  • Interventions: Rehabilitation techniques that ARMHS staff will use to help a person reach objectives, which lead to completing goals. Intervention can focus on using community resources or natural support networks and skill development, mastery or generalization associated with a specific role or setting. The intervention must include the following:
  • A proposed timeline for completion
  • Identified skills or skill set to be learned, mastered or generalized
  • Where the intervention will take place
  • Description of the type of rehabilitative intervention to be used such as demonstrating, modeling, showing or practicing
  • Type of service method, one-on-one or group
  • Length of typical session
  • Frequency of session
  • Timeframes for rehabilitative objectives and interventions
  • Service category: Basic living and social skills (BLSS), medication education (ME), community intervention (CI), transition to community living (TCL) or certified peer specialist (CPS)

Timeframes
A mental health professional or mental health practitioner under the clinical supervision of a mental health professional must complete the following:

  • • Develop and approve an ITP within 30 days of the ARMHS intake or start date
  • • Update the ITP every six months, at a minimum

Signatures
The ITP must be signed by the following:

  • The member must sign and receive a copy of the ITP; if the member is unable to sign the ITP, a reason must be listed
  • The mental health professional and mental health practitioner under the clinical supervision of a mental health professional

Medication Education

The medication education service educates a member about the following:

  • Mental illness and symptoms
  • The role and effects of medications in treating symptoms of mental illness
  • The side effects of medications

Medical education is coordinated with, but not duplicative of, medication management services. The member must be present to bill for the service.

Criteria for medication education are as follows:

  • May include activities that instruct members, families or significant others in the correct procedures for maintaining the member’s prescription medication regimen
  • May be provided individually or in a group setting
  • Must be provided only by a physician, pharmacist, registered nurse or physician’s assistant employed by or subcontracted with a certified ARMHS provider. The ARMHS provider bills for medication education

If medication education is provided in a pharmacy, ensure that the service is provided apart from the dispensing area. Medication education is not intended to replace any aspect of dispensing medications. Information provided to a member as part of a prescription is an aspect of dispensing medications and is paid separately in the dispensing fee, and is not billable as medical education.

Transition to Community Living Services

Transition to community living (TCL) services are developed for the following purposes:

  • To establish or re-establish contact between an ARMHS provider and the member before the member’s discharge from a higher level of care mental health service, including any of the following:
  • Regional Treatment Center
  • Community hospital
  • IMD
  • Intensive residential treatment program
  • Board and care facility
  • Skilled nursing home
  • ACT program
  • To implement the discharge plan developed by the higher level of care mental health service
  • To be coordinated with, but not duplicate, the discharge planning responsibilities of the higher level of care service
  • To be provided within a maximum of 180 days of discharge from the higher level of care service
  • TCL services cannot be provided concurrently with other ARMHS services. TCL is available only when the member is receiving a higher level of care service. TCL services must be authorized according to Authorization Requirements for TCL Services.

TCL services do not count toward the 300 hours or 72-session limit for basic living and social skills or community intervention service categories.

Progress Notes

A progress note describes the rehabilitative service delivered. You must complete a progress note to bill for all services.

Progress notes must include the following:

  • Type of service
  • Date of service
  • Session start and stop times
  • Scope of service (nature of interventions or contacts, treatment modalities, phone contacts, etc.) includes these components:
  • Goal and objective targeted in the session
  • Intervention delivered and methods used
  • Member’s response or reaction to treatment intervention(s)
  • Plan for the next session
  • Service modality (group or individual)
  • Service location
  • Signature and printed name and qualification of the person who provided the service
  • Mental health provider travel documentation requirements
  • Significant observations that may also be documented include the following:
  • Current risk factors the member may be experiencing
  • Emergency interventions
  • Consultations with or referrals to other professionals, family or significant others
  • Summary of effectiveness of treatment, prognosis, discharge planning, etc.
  • Test results and medications
  • Changes in symptoms (physical and mental health)

Noncovered Services

The following services are not covered ARMHS:

  • Transportation services
  • Services provided and billed by providers not enrolled to provide ARMHS
  • ARMHS performed by volunteers
  • Provider performance of household tasks, chores, or related activities, such as laundering clothes, moving the member’s household, housekeeping, and grocery shopping
  • Time spent “on call” and not delivering services to members
  • Activities that are primarily social or recreational, rather than rehabilitative
  • Job-specific skills services such as on-the-job training
  • Time included in case management services
  • Outreach services to potential members
  • Room and board services

Authorization

Request authorization for services exceeding the limits as indicated in the ARMHS Benefits chart in the Billing section for basic living and social skills, community intervention, functional assessment, individual treatment plan and medication education. To request authorization, submit the following:

If ARMHS services are provided concurrently with adult mental health day treatment, the second provider of record must submit the request for authorization. The request must include correspondence from the first provider, which verifies how services will be coordinated and scheduled. This is to assure that the member is receiving distinct periods of service, which occur separately from each other service.

The member’s record must include supporting documentation (the treatment plan) that describes how concurrent ARMHS services are necessary.

Authorization Requirements for TCL Services

Providers must request authorization for all TCL services before service delivery or within a reasonable amount of time after services begin. To request authorization, submit the following:

  • A ”Letter of Referral” requesting ARMHS TCL services
  • The most current documentation associated with the higher level of care service provider type, sufficient to indicate a history of the member’s progress or other changes in mental health status. For example, an IRTS or ACT program would generate the following:
  • Diagnostic assessment
  • Functional assessment
  • LOCUS
  • Interpretive summary
  • Proposed discharge plan
  • Progress notes for the past six sessions or two weeks, whichever is greater (for IRTS – two weeks)
  • The discharge goal, which identifies the functioning that must be restored for the member to successfully reenter his or her community living environment
  • Documentation generated by the ARMHS provider:
  • A brief statement, signed by the ARMHS MHP clinical supervisor, indicating his or her examination of the submitted documentation and eligibility approval for ARMHS
  • The proposed ARMHS TCL plan, which meets the following criteria:
  • Is coordinated with the assessment and discharge plan generated by the higher level of care provider
  • Is limited to a maximum of 180 days, and includes the following:
  • Type of service
  • Frequency and length of sessions
  • Modality (individual or group)
  • Identification of responsible parties
  • A written description of service coordination between the two providers and the member during the TCL plan period, identifying the following:
  • The provider staff involved in coordinating services
  • The provider’s contact information
  • How information will be exchanged
  • The anticipated schedule for ARMHS TCL services on a weekly basis

Billing

Use MN–ITS 837P Professional to bill for all ARMHS.

Enter the treating provider NPI number on each claim line.

Use appropriate CPT modifiers if an ARMHS service is provided on the same day but at different times by any of the following:

Holt Law provides representation in this area for a reasonable flat fee.

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