A Provider’s Guide to Rule 25 Assessments and the new Direct Access process
Timing is one of the most important elements of substance use recovery treatment.
When a provider can swiftly provide intervention to a client who is actively seeking treatment and motivated to make a change—great outcomes happen.
Unfortunately, the times clients are most motivated to change are often when their lives have become chaotic.
When addiction leads to a crisis like the loss of a job, relationship breakdown, financial strife, or any number of other emergencies, clients often reach out for help. But this is precisely the time when issues around insurance or a lack of resources might be a barrier to treatment.
The Minnesota Department of Health initiated the Rule 25 Process several decades ago to address this challenge, which has recently been replaced by Direct Access.
Like all things to do with insurance and public healthcare, navigating these processes can get a little complicated, so we’ll detail everything providers need to know about Rule 25 Assessments and Direct Access below.
What is a Rule 25 Assessment?
Rule 25 was a piece of legislation enacted by the state of Minnesota to improve access to substance use disorder (SUD) treatments, like counseling, residential rehabilitation, or medication-assisted recovery.
Under the Rule 25 process, a person could request an approved social service agency in their country or tribal nation of residence to conduct a Rule 25 chemical use assessment. This process was available to people who were publicly insured (e.g., Medical Assistance), privately insured, or enrolled with a Managed Care Organization (MCO).
Where a person was eligible, they could access public funds from the Behavioral Health Fund (BHF) to cover the full cost of their treatment or any copays. Access to the BHF was, and still is, determined by clinical need (the Rule 25 Assessment Tool and Minnesota Matrix) and financial eligibility.
In short, Rule 25 meant that people in Minnesota of all ages and backgrounds who could not afford substance use recovery treatment, could apply for public funding to get the help they required.
But, the Rule 25 process ended on June 30, 2022, and was replaced by Direct Access.
You may already be familiar with Direct Access. It has actually been available since mid-2018, where a “parallel process” allowed people to seek treatment via either Rule 25 or Direct Access.
You might also notice some people in Minnesota still say “Rule 25”, when they are actually referring to Direct Access. Rule 25 Assessments have been around since the 1980s in Minnesota, so “Rule 25” is often used by clients and providers as a catch-all phrase to describe many of the processes involved in publicly-funded substance use treatment.
Either way, as of July 1, 2022, Direct Access is the only way for a resident of Minnesota to access state-funded substance use treatment, so as a provider, that’s the process you need to understand.
How Does Direct Access Work?
According to the Minnesota Department of Human Services website,
“Direct Access allows an individual to go directly to a provider they choose to receive a comprehensive assessment and access care immediately. Direct Access removes barriers of timing associated with going through a placing authority, allows for individual choice, and removes duplication of comprehensive assessment.”
Many Minnesotans felt that the Rule 25 Assessment process was overly complicated, took a long time, and treatment was tied to the provider who conducted the assessment. Direct Access addresses these complaints to streamline care.
Direct Access also has a lot of benefits for providers.
As a substance use recovery treatment provider, utilizing Direct Access allows you to:
- Expand your client base by providing treatment to clients who may not have otherwise been able to afford your services.
- Diversify your services through offering “comprehensive assessments” (discussed shortly) for clients to obtain treatment through your service or another provider.
- Increase referrals from individuals or organizations wishing to utilize Direct Access, who want to work with a provider who understands the process
Book a free demo of Procentive today!
The Direct Access Process for Providers
If you are operating a licensed SUD treatment program in Minnesota and a client requests treatment under Direct Access, there are five steps you’ll need to be familiar with (adapted from Direct Access: Frequently Asked Questions):
1. Check Coverage
Your first step is to determine if the client has insurance and verify eligibility via MN-ITS. If there is Medical Assistance or OO eligibility, you can continue the Direct Access process immediately.
If they are not automatically eligible for Direct Access, you’ll need to coordinate treatment with the client’s MCO, or connect with their county or Tribe of residence to determine eligibility for the Behavioral Health Fund to cover the cost of treatment and/or copays.
A list of contact information for counties is available at Guide to Minnesota’s Public Health Care Programs.
2. Provide Client Choice
Client choice is a core component of Direct Access.
Before progressing any further, be sure to clearly explain to the client that if they choose to use you for an assessment, they are under no obligation to continue treatment with your service. They are also free to approach any other provider to request an assessment.
3. Review Previous Assessments
When the client has confirmed they want to go ahead with Direct Access and you have confirmed financial eligibility, ask if the client has had any assessments done previously.
If so, request the client to sign a release of information for their provider to obtain the prior assessment.
Because Rule 25 assessments finished in July 2022, it’s possible your client may have had a previous Rule 25 assessment or a comprehensive assessment. If either has been done before, you’ll need to review the previous assessment and update current severity ratings when you complete an assessment.
4. Complete an Assessment
The next step is to complete a comprehensive assessment and comprehensive assessment summary. You must enter these into the client’s DAANES (Drug and Alcohol Abuse Normative Evaluation System) assessment record.
During the comprehensive assessment, you will assess and rate your client against the severity ratings for their existing assessment, or complete a whole new assessment.
Remember, the comprehensive assessment isn’t to determine whether the client is eligible for your services, it is to determine the level of care they require to address their current concerns. They may choose to undertake treatment with you or another provider, so long as their chosen service is equal to or less than what is recommended by the severity ratings.
There is no standard tool or template for the comprehensive assessment or comprehensive assessment summary. However, both should address all of the points in Section 245G.05 of the 2022 Minnesota Statutes. Most providers choose to use a pre-made assessment form or template when completing the comprehensive assessment and summary.
Procentive, our full-featured, simple EHR solution for behavioral health practices, allows you to choose from ready-made dynamic forms and clinical templates, or to make your own. Either independently or with your dedicated success coach, you can design an assessment form to use with clients that covers all the essential points of a Direct Access comprehensive assessment and comprehensive assessment summary.
5. Provide Service or Refer
Finally, if the client needs are aligned with the severity ratings for the level of care you or your agency provide, and they choose to attend your program, you can go ahead and complete the DAANES admission record.
If the client chooses a different provider or is referred elsewhere, you only need to complete the DAANES assessment record.
Making Rule 25 Assessments and Direct Access Easy
Rule 25 assessments and Direct Access bring a lot of benefits for clients and substance use recovery treatment providers. But like most things to do with public healthcare—the process can be complicated!
Fortunately, once you understand what you’re doing and have a system in place, it’s very achievable to add comprehensive assessments for Direct Access to your service offering.
Doing so will not only help clients in need to access treatment, it can also be a great way to expand your client base and grow your business.
The challenge most providers have with Direct Access is not having streamlined processes in place. So do yourself a favor, and try Procentive.
Our intuitive practice management software system contains everything you need to power your practice, all in one place. With an easy-to-use interface, 24/7 web-based access from wherever you are, dynamic forms and templates, and billing and revenue cycle management, Procentive allows substance use recovery treatment providers in Minnesota to manage end-to-end processes for Direct Access and Rule 25 Assessments with ease. Book a demo today to see it in action for yourself.
DateMarch 3, 2023