What is 245G/Substance Use Disorder (SUD) Services?

245G services include assessment of needs, treatment planning and interventions to address client needs as a result of substance use.

The following services are billable as 245G:

• Nonresidential (outpatient) individual and group treatment services
• Residential high, medium, and low-intensity treatment services
• Hospital-based inpatient treatment
• Room and board (when associated with SUD residential treatment)
• Freestanding room and board (when associated with SUD nonresidential (outpatient) treatment)
• Comprehensive assessment
• Treatment coordination
• Recovery peer support
• Residential withdrawal management (245F license)
• Tobacco Use Disorder cessation *
• Substance Use Disorder treatment with Medications for Opioid Use Disorder (SUD-MOUD) services are reimbursed on a per diem basis and may also be included as an add-on to the residential treatment service per diem. SUD-MOUD services may be provided through consultation off site by a qualified practitioner and reimbursed through the member’s medical benefits. SUD-MOUD may include:
  • SUD-MOUD – Methadone
  • SUD-MOUD – Methadone-Plus
  • SUD-MOUD – Other
  • SUD-MOUD – Other-Plus
• When providers are paid the Indian Health Service (IHS) encounter rate, encounter payments are not available for self-administered medication.

* Tobacco Use Disorder cessation when provided as counseling by an alcohol and drug counselor and indicated as needed on a treatment plan can be provided in an individual or group counseling session (H2035 or H2035 HQ). Providing coordination to Tobacco Use Disorder cessation resources can fall under the role of a treatment coordination (T1016 HN U8) by assisting in coordination with and follow up for medical services as identified in the treatment plan or facilitating referrals to SUD services as indicated by a client’s medical provider, comprehensive assessment, or treatment plan.

Services NOT covered under 245G:

• Services delivered before the completion of a comprehensive assessment
• Room-and-board services not clinically or medically necessary
• Treatment services delivered to people enrolled in a managed care plan, with the exception of room-and-board services
• Detoxification services
• Comprehensive assessment, treatment coordination, peer support and nonresidential (outpatient) treatment services when provided by the same residential provider receiving a per diem payment for the same date of service and for the same client.
• Substance Use Disorder treatment with Medications for Opioid Use Disorder services (SUD-MOUD) guest dosing
• Federally Qualified Health Clinics and Rural Health Clinics are not eligible for 1115 rate enhancements.

Who can provide 245G services?

• Eligible providers may include the following:
• Licensed Residential SUD treatment programs
• Licensed Nonresidential (Outpatient) SUD treatment programs
• Counties
• Tribes
• Recovery Community Organizations (RCOs)
• Hospitals
• Federally Qualified Health Clinics, and Rural Health Clinics (as long as they also have a substance use disorder program license)
• Licensed Professionals in Private Practice
• Licensed Withdrawal Management programs

Who is eligible to receive 245G services?

SUD services are available to fee-for-service members with major program code MA, OO (Behavorial Health Fund) and MinnesotaCare. Providers are encouraged to verify member eligibility in MN–ITS on a monthly basis.

If an individual is not already enrolled with Medicaid and has SUD treatment needs, they may be eligible for services through Behavioral Health Fund (BHF) if they meet clinical and financial eligibility requirements:

• BHF financial eligibility determinations are made by the member’s tribe or county of residence. For a person to be eligible for BHF, they must meet the financial eligibility guidelines in Behavioral Health Funds (BHF) Eligibility Determination (DHS-6770) (PDF).
• Clinical eligibility is determined via a comprehensive assessment. See exceptions in the SUD Withdrawal Management Services section of the MHCP Provider Manual.
• Incarcerated individuals who meet financial eligibility guidelines are eligible for payment through the Behavioral Health Fund (major program code OO).

Steps to 245G Certification

Substance use disorder treatment programs are licensed under Minnesota Statutes, chapter 245G to provide treatment services to assist and support a person’s efforts to recover from a substance use disorder. Programs assess a client’s needs, develop planned interventions and provide services to address a client’s needs, coordinate services with other providers, and reassess the client on a regular basis. 

Substance use disorder treatment programs may be licensed as outpatient or residential and may also be licensed to provide the additional services of adolescent treatment, co-occurring mental health disorder treatment, treatment of clients with children, or as an opioid treatment program.

Residential substance use disorder treatment programs that serve people 16 or 17 years of age may be licensed under Minnesota Statutes, chapter 245G or Minnesota Rules, chapter 2960 

Residential substance use disorder treatment programs serving people younger than 16 years of age must be licensed under Minnesota Rules, chapter 2960.

Requirements

Requirements for substance use disorder treatment programs: Minnesota Statutes, chapter 245G

• Minnesota Statutes, sections 245G.01 through 245G.17 apply to all substance use disorder treatment programs. 
• Adolescent programs must also meet the requirements in Minnesota Statutes, section 245G.18.
• Clients with children programs must also meet the requirements in Minnesota Statutes, section 245G.19.
• Co-occurring programs must also meet the requirements in Minnesota Statutes, section 245G.20.
• Residential programs must also meet the requirements in Minnesota Statutes, section 245G.21.
• Opioid treatment programs must also meet the requirements in Minnesota Statutes, section 245G.22.

Requirements for all programs: Minnesota Statutes, Chapter 245A (Human Services Licensing Act)

Requirements for background studies:  Minnesota Statutes, Chapter 245C (Human Services Background Studies Act)

Reporting requirements for maltreatment of minors:  Minnesota Statutes, Chapter 260E

Reporting requirements for maltreatment of vulnerable adults:  Minnesota Statutes, Sections 626.557 and 626.5572

Requirements for payment of consolidated chemical dependency treatment funds:  Minnesota Statutes, chapter 254B

Apply for a license

Apply for a license using the Substance use disorder treatment program license application.

Rates/Reimbursement for Services

Adult Non-Residential Treatment Base Rates

• Individual Treatment / 1 hour / H2035 / $72.11
• Group Treatment / 1 hour / H2035 HQ / $35.03
• Comprehensive Assessment / per session / H0001 / $162.24
• Treatment Coordination / 15 minutes / T1016 / $11.51
• Peer Recovery Support / 15 minutes / H0038 / $15.02
• SUD-MOUD-Methadone / per diem / H0020 / $13.39
• SUD-MOUD-Methadone-all other / per diem / H0047 / $22.66
• SUD-MOUD PLUS  Methadone / per diem / H0020 / $48.42
• SUD-MOUD PLUS all other / per diem / H0047 / $57.69

Additional Resources

MN DHS Substance Use Disorder (SUD) Services

Substance Use Disorder (SUD) Services Enrollment Criteria and Forms

Application Information Session

Substance Use Disorder Treatment