Mental Health Services Payment

Section 140.455 Payment for Mental Health Services
EMERGENCY

a) The amount approved for payment for mental health services described in Section 140.454 shall be based on the type and amount of service required by and actually delivered to a client.

b) The payment amount for a service described in subsections (a) through (c) of Section 140.454 is determined in accordance with the rate methodologies outlined in 59 Ill. Adm. Code 132.60.

c) Advance and Reconciliation of Payments

1) Eligibility. Community mental health providers eligible for this payment, are those that during the payment month:

 

A) have entered into an agreement with the Department, DCFS and DHS to provide SASS

 

B) have entered into an advance and reconciliation agreement with the Department

2) Payment. Payments under this subsection (c)(2) shall be made in each month of the last eleven months of State fiscal year 2006. Each payment shall be one-eleventh of the calculated annual amount, rounded to the nearest whole dollar. The annual amount for each eligible provider shall be one-half of the payable amount of all claims for a service reimbursable under subsection (b) of this Section, provided to a SASS-enrolled child or adolescent during State fiscal year 2005 by the provider (including, in the instance of a partnership arrangement that is formally acknowledged through agreements with the Department, provided by partnering providers), as tabulated by the Department from claims adjudicated through the end of July 2005. Except:

 

A) In the instance that the geographic area assigned to the provider changes from that served during State fiscal year 2005, the Department may adjust the amount of the annual or monthly payments in a manner to reflect the change in service area

 

B) In the instance of a new provider, the Department may base the amount of the annual or monthly payments on the claim experience of the provider that served the area previously.

3) Reconciliation. Reconciliation of the advanced payment shall be effected through recoupment against payable amounts due the provider by the Department, DCFS or DHS, as specified in the advance and reconciliation agreement.

 

4) Effective date. This payment methodology will cease on June 30, 2006.

d) Service Accessibility Assurance Payment

1) Eligibility. Community mental health providers that on June 1, 2005, had entered into an agreement with the Department, DCFS and DHS to provide SASS are eligible for this payment.

 

2) Payment. Payments under this subsection (d)(1) shall be made during the months of June and August 2005. The amount of the payment to an eligible provider shall be determined as the sum of:

 

A) The product of:

 

i) $250,000, and

 

ii) the quotient resulting from the number of children in families that have incomes under 200 percent of the federal poverty income guideline, as reported by the U. S. Department of Commerce from the 2000 census, within the geographic area assigned to the provider divided by the number of children in families that have incomes under 200 percent of the federal poverty income guideline, as reported by the U. S. Department of Commerce from the 2000 census, within Illinois.

B) The product of:

 

i) $375,000, and 

 

ii) the quotient resulting from the number of square miles of land, rounded to the nearest whole square mile within the geographic area assigned to the provider, as reported by the U. S. Department of Commerce from the 2000 census, divided by the number of square miles of land, rounded to the nearest whole square mile, within Illinois.

C) The product of:

 

i) $750,000, and

 

ii) the quotient resulting from the number Medicaid eligible SASS-enrolled children and adolescents who received a service, other than a pre-admission screening, reimbursable under subsection (b) of this Section from the provider (including, in the instance of a partnership arrangement that is formally acknowledged through agreements with the Department, provided by partnering providers), as tabulated by the Department from adjudicated claims, divided by the sum, across all eligible providers, of the number Medicaid eligible SASS-enrolled children and adolescents who received a service, other than a pre-admission screening, reimbursable under subsection (b) of this Section, as tabulated by the Department from adjudicated claims. Calculation of the June payment will include claims adjudicated through the end of May; calculation of the August payment will include claims adjudicated through the end of July.

3) Effective date. This payment methodology is effective June 1, 2005, and will cease on August 30, 2005.

(Source: Amended by emergency rulemaking at 29 Ill. Reg. ___________, effective June 1, 2005, for a maximum of 150 days)