NW8 Policy Handbook

NW8 Adult Mental Health Initiative
Policy Handbook

Shannon Abrahamson
10-16-2025

Table of Contents

1.1  Governing Board Operating By-Laws

1.2   Decision Making Process

1.3   Contingency Plan

1.4   Nondiscrimination Policy

1.5   Transition Plan

1.6   Grant Monitoring Policies & Procedures

1.7   Conflict of Interest Policy

1.8   Flex Funding Policy

1.9   Community Education & Prevention Policy

Board Approved 11.12.2025

1.1
Governing Board Operating By-Laws

A. NAME

The Name of this group shall be NW8 Adult Mental Health Initiative Governing Board.

B. AUTHORITY

The authority of the respective County Mental Health Authorities in accordance with

M.S. 245.4661 establishes the NW8 Adult Mental Health Initiative Governing Board. The NW8 Adult Mental Health Initiative Governing Board shall operate under limited authority granted to it by the respective County Mental Health Authorities such that authority not expressly granted to the NW8 Adult Mental Health Initiative Governing Board by individual County Boards is reserved to those County boards.

C. PURPOSES

The NW8 Adult Mental Health Initiative Governing Board exists to plan and develop with the group’s geographic jurisdiction, a system of care that will serve the needs of adults with serious and persistent mental illness. The specific purposes of the NW8 Adult Mental Health Initiative are as follows:

Mission and Principles:

NW8 AMHI is dedicated to improving the mental health of community through intentional planning and partnerships across a region grounded in the following principles:

Lived experience with mental illness guides the governance and services.

    • Brings together people with lived experience including the County LAC’s, providers, counties, tribes, MCOs and DHS to fully utilize all available resources to meet regional needs.
    • Develops and provides an array of person-centered services that builds on personal and cultural strengths.
    • Utilizes a data driven model to evaluate the impact of services on health outcomes. Assures access, early intervention, coordination, and application of resources through creative partnerships.

Roles and Responsibilities: The AMHI members are expected to:

    • Identify regional needs
    • Prioritize areas for development
    • Use data to assess current services
    • Plan for current and future mental health services.
    • Provide Fiscal Accountability Structure
    • Make specific recommendations regarding system design to the respective County Mental Health Authorities
    • Implement a mental health service delivery system for adults with serious and persistent mental illness. That such effort will:
      • provide an array of mental health services
      • be based on strategies that improve access and coordination of services,
      • incorporate existing State resources into the community mental health infrastructure
      • utilize existing categorical funding streams and reimbursement sources in combined and creative ways.

D. MEMBERSHIP

The membership of the NW8 Adult Mental Health Initiative (AMHI) is comprised of one representative from Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake & Roseau County Social Services. The Governing Board will consist of eight (8) voting members to be selected in the following manners:

The following will comprise the membership of the Governing Board.

8   One voting Representative from each of the participating counties

1    Ex-officio Local Advisory Council member nominated by the Local Advisory Council to act on behalf of people with lived experiences.

1    Ex-officio non-voting Provider Representatives

1    Ex-officio non-voting AMHI Coordinator Representative selected by the Human Services Directors

1    Ex-officio non-voting Representative appointed by the Behavioral Health Division from the Minnesota Department of Human Services.

1    Ex-officio non-voting MCO Representatives

Representatives designated by a County Mental Health Authority need to be empowered to act on behalf of the appointing authority.

E. OFFICERS

The NW8 Health and Human Services Directors will rotate as Chair starting with Kittson County in 2022. The rotation will go in alphabetical order by county, and each will serve in their position for a two (2) year term excluding the fiscal host, Polk County.

The Chairperson will change on January 1 at the end of the two (2) year term with optional yearly extensions. Any county may decline nomination of chairperson for their designated cycle. The chair would then move to the next county in line.

Kittson County
Mahnomen County
Norman County
Pennington County
Red Lake County
Roseau County
Marshall County

DUTIES OF OFFICERS Chairperson – the duties of the Chairperson are:

  • Work closely with AMHI Coordinator to prepare agendas, AMHI documents and reporting procedures.
  • Chair the Governing Board meetings.
  • Make necessary appointments to committees, tasks forces and other such groups that is within the Governing Board scope of responsibility.
  • Provide guidance to the AMHI Coordinator
  • Work closely with fiscal host to ensure spending is on target for AMHI and Crisis budgets.
  • Work closely with Alluma and County Directors to complete AMHI Coordinator’s annual review

The Chairperson is responsible for delegating a County Director to chair the Governing Board meetings in their absence

F. GOVERNING BOARD

The Governing Board is a standing Committee.

The Governing Board shall provide oversight to the work of any personnel doing Sub Committee business.

The Governing Board will be responsible for providing oversight for any Sub committees that may need to be established. Sub committees will be established as needed to perform specific tasks for the Governing Board. At least one County Representative from the NW8 will serve on each team to maintain continuity of the Governing Board.

Governing Board Member Responsibilities:

  • To attend all regularly scheduled meetings of the general membership, assigned sub committees and Governing Board.
  • To focus on the long-range vision and strategic plans based on feedback from the Local Advisory Council & Adult Mental Health Case Managers.
  • To supervise the activities, evaluate progress, review and approve expenditures.
  • Give recommendations and assistance as requested on matters related to Mental Health Services design and delivery within the NW8.
  • The Governing Board shall have responsibility for determination of spending of AMHI grant funds.
  • Ensure the NW8 Adult Mental Health Local Advisory Council unmet mental health needs is reported to the County Board in the represented county and is included in the county’s biennial mental health component of the community social services plan.
  • Fiscal Host is responsible for contracts with regional vendors of services within the Region.
  • Fiscal Host is responsible for performing annual site visits and audits per the NW8 AMHI & CSP Grant Monitoring Policies and Procedures.
  • The AMHI Coordinator is responsible for acting as the liaison between the AMHI Governing board and the Local Advisory Council, Adult Mental Health Case Managers, Adult Mental Health Supervisors and Care teams to report back the needs in the NW8.

G. MEETINGS

The Chairperson holds meetings of the full Governing Board at such times as determined necessary. Meetings will be held the second (2nd) Wednesday of every other month in the morning, or as agreed in advance by the Governing Board. All meetings are open to the public and meet the Open Meeting Law requirements. Open Meeting Law. Meeting minutes are posted to the AMHI website following each Board meeting www.nw8amhi.org.  Meetings will be held in a location central to the geographic planning area. Any additions requested to the agenda shall be made to the chair or AMHI Coordinator; changes will be at the discretion of the chair. A Local Advisory Council member selected by the LAC will represent individuals with lived experiences at the Governing board meetings.

H. VOTING

An attempt will be made to settle all Governing Board issues through a consensus reaching process; however, majority vote shall rule on all Governing Board issues. The simple majority rule process shall extend to all committee issues as well. For full Governing Board meetings only county representative are considered voting members. Each county shall have one vote.

I. CONFLICT OF INTEREST

If a conflict of interest arises, member must make it known to the Governing board and abstain from voting.

J. AMENDMENTS AND BY-LAWS REVIEW

The Governing Board will review these By-laws for revisions on an annual basis. The Governing Board at a regularly scheduled meeting must approve any changes in the By-laws. Amendments can be recommended at any regularly scheduled meeting of the Governing Board and approved by an affirmative vote of the full Governing Board membership.

K. QUORUM

A simple majority of the current County Representatives present with a minimum of five (5) Counties represented shall constitute a quorum.

1.2
Decision-Making Process

PURPOSE

To outline the process by which NW8 AMHI makes collaborative, transparent, and timely decisions that support service planning, funding, and coordination of adult mental health services across the region.

GUIDING PRINCIPALS

  • Collaboration: Decisions are made with input from all regional partners, including counties and people with lived experience.
  • Transparency: Information is shared openly to promote accountability and trust.
  • Client-Centered: All decisions prioritize the well-being and needs of individuals with serious and persistent mental illness (SPMI).
  • Equity: Cultural responsiveness and equitable access across all counties in the NW8.

Efficiency: Processes are streamlined to ensure timely action.

GOVERNANCE STRUCTURE

Group

Role & Responsibilities

AMHI Governing Board

Comprised of the NW8 County Human Services Directors. Provides final approval on funding allocations, program design, and policy positions.

AMHI Chair/Coordinator

Facilitates regional meetings, prepares agendas and documentation, provides data to support decisions, and ensures follow-up.

Fiscal Host

Manages budget and payments, provides financial updates, performs grant monitoring and ensures alignment with DHS reporting.

Subcommittees or Workgroups

Formed for specific projects. Present

findings and recommendations to the Governing Board.

‌DECISION-MAKING PROCESS

‌Issue Identification

‌Any stakeholder (county, provider, or committee member) may bring a new topic, concern, or opportunity forward to the AMHI Coordinator or during a regular meeting.

Discussion & Data Gathering

The AMHI Board Chair facilitates discussions with input from relevant parties.

This may include:

  • Client data and outcome
  • Funding impacts
  • Provider capacity
  • DHS policy guidance

Proposal Development

A recommendation or proposal may be developed by a subcommittee, county, partner, or AMHI Coordinator.

This may include:

  • Background and need
  • Financial impact
  • Implementation considerations
  • Alternatives (if any)

‌Review and Input

The proposal is presented to the Governing Board.

Ample time is provided for:

  • Questions and clarifications
  • County-specific considerations
  • ‌Public or advisory input (when appropriate)

Decision

  • The Governing Board votes by simple majority with a minimum of (5) Counties represented shall constitute a quorum.
  • ‌If consensus cannot be reached, the Chair facilitates further dialogue or tables the issue for additional work.

Implementation

‌Once approved, the Coordinator, Chair and Fiscal Host coordinate implementation, including provider communication, contracting, or service changes.

Monitoring & Evaluation

Decisions are reviewed annually to assess effectiveness. Data is shared back to partners to guide future adjustments.

‌EMERGENCY OR TIME-SENSATIVE DECISIONS

‌In urgent cases (e.g., service disruption, immediate DHS deadline), the AMHI Coordinator may call an emergency virtual meeting or request an email vote from board members. All emergency decisions are documented and reviewed at the next regular meeting.

DOCUMENTATION

Meeting minutes are recorded and posted to the NW8 AMHI website for all official decisions.

1.3
Contingency Plan

‌PURPOSE

To ensure the NW8 Adult Mental Health Initiative (NW8 AMHI) can continue to deliver essential mental health services to adults during emergency situations such as natural disasters, pandemics, cyberattacks, and other operational disruptions. This plan applies to all AMHI-funded programs and services across participating counties in the NW8 unless a program specific plan is in place.

‌All interruptions in service will be communicated to the NW8 AMHI utilizing the following communication plan.

  • Notification will be made to the following:
    • NW8 AMHI Coordinator
    • NW8 AMHI Chair
    • Fiscal Agent- Polk County Social Services Director
  • Name, phone and Email for the NW8 AMHI Contacts will be provided within this document and updated as needed.

Upon notification of service interruptions, the NW8 AMHI will work to determine the following:

  • Length of interruption
  • Impact of interruption
  • Temporary Plan to accommodate service interruption

SERVICE INTERUPTION/CONTIGENCY PLAN DEVELOPMENT

Contingency Planning Team

The NW8 AMHI Board in coordination with the AMHI Coordinator will serve as the Contingency Planning Team (CPT). The CPT will be responsible for developing a program specific contingency plan. This plan will be communicated to impacted areas. The CPT will have discretion to coordinate an emergency meeting with the NW8 AMHI board.

Contacts:

NW8 AMHI Coordinator: Shannon Abrahamson, Shannon.abrahamson@allumacares.org
NW8 AMHI Chair: Julie Hanson, julie.hanson@co.mahnomen.mn.us
Fiscal Agent: Karen Warmack, Karen.Warmack@polkcountymn.gov

‌1.4
Nondiscrimination Policy‌

POLICY

NW8 AMHI ensures all individuals are entitled to equal access to services, without regard to race, color, national origin, sex, age, religion, creed, disability, marital or public assistance status, sexual orientation or gender identity. Auxiliary aids, interpreters, and language services are provided at no cost, upon request. Complaints can be filed internally via our contact form at www.nw8amhi.org or externally with the Minnesota DHS Civil Rights Coordinator, MN Department of Human Rights, or U.S. HHS OCR. No retaliation will occur for filing a complaint.

1‌.5
Continuity of Care Transition Plan‌

‌PURPOSE

‌This plan establishes the NW8 AMHI’s commitment to ensuring continuity of care for individuals with serious and persistent mental illness (SPMI) in the event of contract termination with the NW8 AMHI and a Community Mental Health Center (CMHC) or Community Support Service (CSS) program.

‌POLICY STATEMENT

In accordance with Minn. Stat. § 245.466, subd. 3a, the NW8 AMHI and its member counties (Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake, and Roseau) will take all necessary steps to prevent disruption of mental health services when a contracted provider discontinues services.

NW8 AMHI will, in accordance with MS 245.466 subdivision 3a, provide a 90-day notice to the contracted provider and to the Minnesota Commissioner of Human Services of our intent to end a contract. It is our expectation that all contracted providers extend our agency the same courtesy. All affected clients will be notified of the contract termination in writing and given information on how to transfer their care and medical records to new providers.

If there are no local providers available to provide the service, agency workers will assess the client’s needs and refer them to the next possible service provider that would best fit their needs and location. Due to the remote nature of our region, services may need to be obtained outside of the local area until a local provider can be secured.

1‌.6
Grant Monitoring and Financial Review Policy

POLICY

Under this policy, NW8 Adult Mental Health Initiative will:

  • Conduct Site visits for all contracts over $50,000 before the end of the contract period and annually for all contracts over $250,000
  • Will review invoices annually to ensure spending matches invoices for contracts over$50,000 within that invoice period
  • Review data in each of the contracts to ensure dollars do not exceed services being provided

SITE VISITS, DATA REVIEW & FINANCIAL RESPONSIBILITIES

  • NW8 AMHI will utilize the Crisis and ARMHS site visits conducted by the Department of Human Services Mental Health Division at Alluma and Sanford Behavioral Health to ensure all practices continually meet the service requirements of Minnesota Rule 9505.0372.
  • Polk County Social Services will review 10 physical claims through Q3 annually for State grant compliance for each provider.
  • PCSS will review records received from Alluma & Sanford for each client to ensure services being provided are meeting the allowable services outlined in the State contract.
  • PCSS will report out findings to the AMHI board and Providers during quarter one of the AMHI meetings.
  • If 50% or more records are inaccurate upon review, the NW8 AMHI will perform a full-service line audit with that Provider.
  • The NW8 Adult Mental Health Initiative will review financials at each Board meeting to ensure spending is meeting the service agreement contracts.
  • The board will review all contracts to assess whether totals seem appropriate given the contracted service and dollar amount on an annual basis.

1.7
Conflict of Interest Policy

  1. This policy is intended to address potential conflicts of interest including matters of material financial interest, or situations involving a private interest or for personal benefit.
  2. The policy applies to all members of the NW8 Adult Mental Health Initiative Board.
  3. No member of Organization Name Board of Directors or Staff shall derive any personal profit or gain, directly or indirectly, by reason of his or her participation with the NW8 Adult Mental Health Initiative. This shall also include the member’s business or other nonprofit affiliations, family and/or significant other, employer, or close associates who may stand to receive a benefit or gain.
  4. Any new member of the Board shall be given this policy at the time of their selection or appointment.
  5. Each Board member has a duty to disclose to the Board Chair any personal interests which he or she may have in any matter pending before the organization.
  6. Such member shall also refrain from participating in any discussion or decision on such matter, as well as any attempt to influence other members of the Board.
  7. If the Board Chair determines that a potential conflict of interest situation exists, they will review the matter with the Board to determine what action, if any, is warranted.
  8. A financial interest or potential financial interest is not necessarily a conflict of interest until determined as such by the board.
  9. All discussions and decisions regarding the application of this policy shall be recorded in the minutes of the NW8 AMHI board.

1.8
NW8 AMHI Flex Funds Policy

POLICY

AMHI Flex Funds are to be used as means to help supplement the financial burden that may impact the mental health of individuals served in our region. Funds are intended for mental health service consumers to assist with improving or maintaining management of mental health symptoms and overall level of functioning (independent living), preventing the need for a higher level of care or additional services. The brass code definition (code 418x) is defined as “Non-housing related goods or services purchased on behalf of a client to meet basic physical, mental health or medical needs. Examples include medications, clothing and food. Note: if housing-related, use 443x Housing Subsidy”.

To help with the administration of flex funds please use the following guidelines:

  • To be considered for Flex Funds, consumers must have a current mental health need. The request for funds must be related to overall functioning of the consumer requesting the funds and help prevent decompensation or need for additional care/services.
  • When other financial resources are available to the flex fund request, those resources (e.g. housing assistance, fuel/electric assistance, LifeLine phone assistance, etc.) should be exhausted prior to flex funds being considered.
  • Administration of flex funds must occur through a trackable system with checks and balances.
  • Individual counties are responsible for the funds allocated to them.

    1.9
    Community Education & Prevention Policy

    The NW8 Adult Mental Health Initiative (AMHI) serves people in Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake and Roseau Counties. We focus on improving mental health in our communities by providing access to affordable support and services through local resources and education. The NW8 AMHI identifies gaps in the service area and works to bridge those gaps for individuals being served.

    The AMHI Community Education & Prevention funds are to be used to educate the public about mental health and co-occurring issues. The brass code definition 402x is defined as “Activities designed to educate the public about mental health and co-occurring issues. Goals are to increase understanding of mental health, reduce stigma, promote recovery and increase awareness of availability of resources and services, improving skills in dealing with mental health issues.”

    The AMHI Strategic Planning subcommittee “Goal #2: Educate Communities on mental and behavioral issues and the impact of the AMHI” will make recommendations to the AMHI board for the annual allocations at the November meeting prior to the next grant year cycle.

    Subcommittee members are made up of regional Providers and Partners that are represented at the AMHI meetings and assigned by the board for the duration of each grant cycle. The subcommittee will be facilitated by the AMHI Coordinator and/or a Director of one of the County Social Services representing the NW8 AMHI.

    The subcommittee will meet monthly or as needed with a minimum of four times per year for the duration of the grant cycle.

    The funds will be considered for existing activities such as, but not limited to:

    • Website development & maintenance
    • Subscriptions
    • Local Advertising
      • Social Media
      • Radio
      • Movie Theatre
      • Virtual & Static Billboards
    • Adult Mental Health Local Advisory Council
    • Printed outreach materials
    • Sponsoring Community events
      • Health Fairs
      • County Fair Booths
      • Mental Health & Suicide Awareness Events
      • Speakers
      • Trainings

Sponsorship is determined based off the criteria outlined in the 402x definition listed above.

Sponsorship requests will be reviewed by the subcommittee and recommendations will be brought to the AMHI board for final approval.

Process for requesting sponsorship funds will be posted on the AMHI website.

1.10
Uncompensated Care Policy

PURPOSE

The purpose of this Uncompensated Care Policy is to ensure that adults with serious and persistent mental illness (SPMI) residing in the NW8 Adult Mental Health Initiative (AMHI) service area are not denied access to essential mental health services due to financial hardship. This policy establishes consistent guidelines for the appropriate and responsible use of AMHI funds to support allowable uncompensated care when no other payer source is available or accessible in a timely manner.

This policy is intended to:

  • Promote continuity of care and timely access to medically necessary mental health services
  • Ensure AMHI funds are used as a payer of last resort
  • Support providers in delivering critical services while maintaining fiscal accountability
  • Ensure equitable and transparent allocation of limited AMHI resources across the service area

LEGAL REFERENCES & AUTHORITY

  • Minnesota Statute 245.461 – Establishes the mission to create and ensure a unified, accountable, comprehensive adult mental service system.
  • Minnesota Statute 245.462 Subd 20 – Defines Serious and Persistent Mental Illness (SPMI) and includes definitions related to adult mental health services.
  • Minnesota Statutes Chapter 253B – Governs civil commitment and court-ordered mental health treatment, including pre-petition screenings and hearings.
  • Minnesota Statutes Chapter 246B – Establishes standards for mental health services, including licensing, service delivery requirements, and quality standards.
  • Minnesota Statutes Chapter 256B – Governs Medical Assistance (MA), including eligibility verification and coordination of benefits.
  • Minnesota Statutes 62J – Covers health insurance reporting requirements and coordination of benefits to ensure AMHI funds are used as payer of last resort.
  • HIPAA – 45 CFR Parts 160 & 164 – Ensures confidentiality, privacy, and security of client health information.

DEFINITIONS

  • Uncompensated Care: Individual does not have insurance or has insurance that does not cover the needed behavioral health services.
  • Uninsured Adult: an adult without any form of health care coverage and has been denied or not eligible for Medical Assistance
  • Underinsured Adult: an adult with Medicare or private insurance, with a service need that is not covered by their existing plan, and they are not eligible for Medical Assistance.
  • Serious and Persistent Mental Illness (SPMI): As defined in Minnesota Statutes 245.462 Subd 20, a mental disorder that is severe and persistent in nature, results in substantial functional impairment, and requires ongoing treatment and support.
  • Provider: Any AMHI-contracted or enrolled entity, professional, or organization authorized to deliver mental health services and submit claims for uncompensated care reimbursement under this policy.
  • Eligible Services: Services defined in this policy that may be reimbursed using AMHI funds, including outpatient psychotherapy, mobile crisis services, residential crisis stabilization, Assertive Community Treatment (ACT), and other services listed under the Covered Services section.
  • Payer of Last Resort: AMHI funds are only used after all other public or private funding sources have been pursued or are unavailable, ensuring compliance with state and federal regulations.
  • Crisis or Urgent Care: Mental health services required immediately due to a significant risk to the client’s or others’ health or safety, including situations such as suicidal ideation, acute psychiatric episodes, or imminent risk of harm.

POLICY STATEMENT

AMHI-funded providers shall not deny services based on an individual’s inability to pay. AMHI funds are intended as a payer of last resort and may only be used when all other public or private funding sources have been explored and are unavailable in a timely manner. Eligible services include medically necessary mental health services as defined by Minnesota Administrative Rules and the NW8 AMHI service definitions. Funding decisions must be applied consistently, equitably, and without discrimination, and reimbursement is contingent upon proper documentation demonstrating eligibility, efforts to secure other funding, and compliance with DHS audit standards. AMHI funds may also be used to ensure timely access to care and may be applied immediately for crisis or urgent care services regardless of the individual’s insurance enrollment status.

CLIENT RIGHTS

Individuals receiving services supported by AMHI uncompensated care funds have the right to:

  • Receive mental health services without discrimination based on inability to pay
  • Be treated with dignity and respect
  • Be informed when uncompensated care funds are being used on their behalf
  • Receive services without delay due solely to financial hardship
  • Apply for and receive assistance in accessing all other available public or private funding sources

Use of uncompensated care funds does not limit or replace an individual’s rights under applicable state or federal law, including the Minnesota Comprehensive Adult Mental Health Act, Minnesota Statutes, sections 245.461–245.486.

ELIGIBILITY

AMHI funds may be used to cover the cost of mental health services when all of the following conditions are met:

  1. The individual is an adult (aged 18 or older).
  2. The individual has a verified Serious and Persistent Mental Illness (SPMI) diagnosis or a scheduled diagnostic assessment.
  3. The individual resides within the NW8 AMHI service area, verified by documentation such as a driver’s license, utility bill, or case manager attestation.
  4. All other funding sources have been exhausted or are unavailable in a timely manner. Providers must document efforts to secure coverage through public programs (e.g., Medical Assistance, MinnesotaCare, VA Healthcare) and private insurance or assistance programs.
  5. Individuals who refuse to provide insurance information or refuse to apply for available public programs may not be eligible.
  6. Transition to Other Coverage: Individual must receive a prior authorization and will have up to 180 days from the start of services to enroll in available public or private coverage. AMHI funds may only be used during this 180-day period unless a case-by-case exception is granted. For crisis or urgent mental health services, this 180-day requirement may be waived to ensure immediate access to care, but providers must document efforts to assist the individual in obtaining coverage as soon as reasonably possible. 

DURATION AND LIMITS OF COVERAGE

Uncompensated care funding is intended to be short-term and transitional in nature and may be authorized only for the period during which an individual is uninsured, underinsured, or unable to access other available funding sources. Coverage is limited to the minimum duration and level of services necessary to ensure access to essential mental health services while other payer sources are actively pursued. Authorization of uncompensated care does not guarantee ongoing or future funding and is subject to annual budget limitations, per-client or per-service caps established by the NW8 AMHI board, and verification of continued eligibility. Funding may be discontinued once insurance coverage becomes available, or eligibility criteria are no longer met.

AUTHORIZATION PROCESS AND DECISION AUTHORITY

Requests for uncompensated care funding must be submitted by enrolled AMHI providers using the required NW8 AMHI Uncompensated Care Authorization Form and all required supporting documentation. Completed requests must be submitted via secure email to the AMHI Coordinator and will be reviewed for eligibility. The NW8 AMHI Coordinator, or its designee, will review completed submissions. The NW8 AMHI Coordinator, or its designee, retains final authority to approve, deny, or limit uncompensated care requests based on eligibility, documentation, and availability of funds, and may establish additional approval thresholds or limitations as necessary to ensure equitable and fiscally responsible use of AMHI funds.

APPEALS AND DISPUTE RESOLUTION

Providers may appeal a denial or partial approval of uncompensated care funding by submitting a written request for reconsideration to the NW8 AMHI Coordinator within 30 calendar days of the decision notice. The appeal must include the reason for the appeal and any additional supporting documentation. Appeals will be reviewed by the NW8 AMHI board, or its designee, and a written determination will be issued within 45 calendar days of receipt of the appeal. Decisions made through the appeal process are final. This appeals process does not limit an individual’s rights under applicable state or federal law.

DOCUMENTATION & RECORD RETENTION REQUIREMENTS

Providers seeking reimbursement for uncompensated care must maintain complete, accurate, and auditable documentation to support client eligibility, services provided, and efforts to secure all other funding sources. Required documentation must include, at a minimum: verification of residency within the NW8 AMHI service area; documentation of SPMI diagnosis or scheduled diagnostic assessment; evidence of denial or ineligibility for other public or private insurance coverage; and service documentation consistent with applicable Minnesota Administrative Rules, Medicaid/AMHI program requirements, and HIPAA privacy and security standards.

All records related to uncompensated care claims, including invoices, supporting documentation, and client eligibility information, must be retained for a minimum of seven (7) years from the date of service or final payment, whichever is later, and must be made available upon request to NW8 AMHI, DHS, or other authorized oversight bodies for monitoring, audit, or compliance reviews. Providers are responsible for ensuring that documentation meets DHS standards for fiscal and program integrity audits, and failure to maintain required documentation may result in denial of reimbursement or recoupment of funds.

BILLING & PAYMENT STANDARDS

All uncompensated care invoices must include authorization # and be submitted within sixty (60) calendar days of the date of service, except in cases of documented extenuating circumstances or crisis services. Incomplete submissions will be returned to the provider for correction and may delay or result in denial of payment.

Providers may not bill uncompensated care funds for services that are covered by an individual’s active private or public insurance. If an individual is enrolled in an insurance plan that covers the service, the provider must bill the applicable insurance prior to submitting a claim for uncompensated care. Failure to pursue available insurance coverage constitutes noncompliance with this policy.

Payments will be made based on verified eligibility, allowable service codes, units or hours of service, and the availability of AMHI funds. Providers must submit accurate and complete billing information, including all relevant private or public insurance details, and attest that all reasonable efforts have been made to secure other available funding sources.

Approved payments will be issued within sixty (60) calendar days of claim approval. All payments are subject to review and audit by NW8 AMHI or DHS. Providers are required to repay any funds identified through audit as ineligible, improperly documented, or noncompliant with this policy or applicable state and federal regulations.

EXCLUSIONS

AMHI funds may not be used for the following:

  • Lump sum payment not specific to an individual
  • Medical Assistance (MA) program spenddowns
  • Medical Assistance (MA) program co-pays
  • Alternative Care (AC) waiver client responsibility fees
  • Medicare premiums and/or co-pays
  • Private insurance co-pays or deductibles
  • MinnesotaCare premiums and/or co-pays
  • Uncompensated care provided during periods of incarceration
  • Substance Use Disorder (SUD) services
  • Community Support Program (CSP) no-show appointments

COVERED SERVICES

Eligible services may include:

  • 408x Adult Outpatient Diagnostic Assessment / Psychological Testing / Explanation of Findings
  • 416x Transportation
  • 420x Peer Support Services
  • 431x Adult Mobile Crisis Services
  • 436x Adult Residential Crisis Stabilization
  • 438x Assertive Community Treatment (ACT)
  • 446x Basic Living / Social Skills and Community Integration
  • 452x Adult Outpatient Psychotherapy
  • 454x Adult Outpatient Medication Management
  • 468x Adult Day Treatment
  • 469x Partial Hospitalization
  • 474x Intensive Residential Treatment Services (IRTS)
  • 491x Adult Rule 79 Targeted Case Management (TCM)

PROVIDER COMPLIANCE & ACCOUNTABILITY

Providers are responsible for ensuring that all uncompensated care services billed under this policy are delivered in accordance with eligibility criteria, service definitions, and documentation requirements. Providers must make reasonable efforts to assist clients in applying for all available public or private funding sources and attest to such efforts on each authorization form submission.

Failure to comply with this policy, including submission of inaccurate or incomplete documentation, billing for ineligible services, or failure to pursue other funding sources, may result in:

  • Denial or recoupment of uncompensated care payments
  • Suspension or termination of eligibility to submit future claims
  • Referral for further review or corrective action by the NW8 AMHI board or DHS

Providers are also expected to cooperate with audits, monitoring, and requests for additional information from NW8 AMHI or DHS. Compliance with this policy ensures fiscal integrity, equitable distribution of AMHI funds, and continuity of care for individuals with serious and persistent mental illness in the NW8 service area.

NW8 AMHI Uncompensated Care Authorization Form

Date:

Client Name:

Date of Birth:

County of Residence:

List date(s) of service:

Service Type: (Include all Brass Codes that will be billed for this client under Uncompensated care)

Does client have existing insurance coverage?

If so, what type?

Date insurance enrollment is anticipated:

Reason the individual is uninsured/underinsured:

Describe team efforts made to obtain insurance coverage. (list of applications submitted and/or options explored):

Provider attests that it has made reasonable efforts to collect from all possible funding sources, including assisting client with completing applications for any government funded assistance they may be eligible for. Provider attests the client meets all eligibility criteria for uncompensated care funds as outlined in the NW8 AMHI Uncompensated Care Fund Policy. Insurance denial will be provided upon request.

Date________
Signature__________________________________
Print Name_________________________________                      Provider___________________________________

This handbook was reviewed and adopted by the NW8 Adult Mental Health Initiative, Board Approved 11.12.2025.