Provider Notice issued 06/17/04

Children's Mental Health Screening, Assessment and Support Services (SASS) Program

This statewide initiative will: (1) provide screening, assessment and treatment of any child who may be at risk of psychiatric hospitalization and who is eligible for public funding under any of the programs administered by one of the three collaborating departments; (2) enhance access to coordinated community-based mental health services either in lieu of or following in-patient care; and (3) effectively link families and guardians to the appropriate levels of care to meet the mental health treatment needs of a child. The purpose of this notice is to explain the various policy and procedures for this program. Additional information regarding SASS requirements will be sent to hospitals in the near future.

The SASS program has two components: A Crisis and Referral system known as CARES that operates through a 1-800 phone line and geographically dispersed screening agents known as SASS providers. The handbook for Providers of Screening, Assessment and Support Services (CMH-200) can be accessed on the department's Web site at <http://www.illinois.gov/hfs/MedicalProviders/Handbooks/Pages/default.aspx>

Target Populations

There are three target populations for the SASS program: (1) all children for whom DCFS is legally responsible; (2) children for whom DHS has been requested to pay for their hospitalization; and (3) children enrolled in DPA's Medical Programs.

Statewide Crisis and Referral Entry Service (CARES) "800" phone line

Providers who determine that a child is experiencing a mental health crisis and is at risk for hospitalization must contact the CARES at 1-800-345-9049, TTY 1-800-905-9645 . The CARES will determine if the case is clinically appropriate for a SASS referral. At the time CARES refers the case to the SASS provider, a prior approval is entered into DPA's system authorizing SASS. Please note, hospitals are required to contact CARES prior to admitting a child for psychiatric services.

Effective July 1, 2004, the departments have contracted with Westside Youth Network, the CARES vendor, to provide prior approvals for admission into the program and to authorize SASS. To request a prior approval, contact the CARES at 1-800-345-9049, TTY 1-800-905-9645 , seven days a week, 24-hours a day. For children with a MediPlan or KidCare card, all regular Medical Programs payment policies apply.

SASS Providers

The collaborating departments have entered into agreements with SASS providers who will perform the screenings and authorize the SASS services. Each SASS provider is responsible for coverage of a specific geographical area, referred to as a Local Area Network (LAN). LANs, which include out-of-state counties contiguous to Illinois, are areas designated by DHS and DCFS to facilitate the delivery and coordination of mental health services. A listing of these providers will be posted to the department's Web site before July 1, 2004 at the following link: <http://www.illinois.gov/hfs/MedicalProviders/behavioral/sass/Pages/sassproviders.aspx>

Although there are specified SASS providers, this does not prevent a community mental health (CMH) provider from serving a child enrolled in the SASS program. Each child and family is free to choose any enrolled CMH provider to provide SASS support services. The SASS provider may either provide the SASS support services, or refer the child to another provider enrolled with DPA's Medical Programs. The CMH provider must simply have a referral entered by CARES into the DPA's prior approval system. After receiving the approval, the provider is then allowed to bill for SASS. The SASS program is not designed or intended to discourage the child/family from seeing their current provider.

SASS for Children Without a MediPlan or KidCare Card ? SASS Special Eligibility Notice

If a child, who is not eligible for coverage under one of DPA's Medical Programs, is screened and authorized for SASS, they will receive a Notice of Temporary Eligibility. The temporary eligibility notice will be issued on an 8½" x 11" sheet of paper. Coverage will be limited to the time period authorized by CARES for SASS services. A facsimile of the notice will be posted to the department's Web site prior to July 1 st at the following link: <http://www.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx>

Children with temporary coverage are eligible only for services authorized through SASS, transportation to and from these services and certain classes of pharmaceuticals. The initial prior approval authorizes the delivery of SASS for a period of 90 days by the SASS provider that performs the screening. A referral to another SASS provider, or a community mental health provider enrolled with DPA, must be registered by CARES and receive prior approval. Pharmacy benefits are subject to existing DPA prior approval policy. They do not require authorization by the SASS provider.

A listing of pharmaceuticals covered for children with temporary coverage is posted on the department's Web site at the following link: <http://www.illinois.gov/hfs/MedicalProviders/behavioral/sass/Pages/preferred.aspx>. DPA prior authorization requirements for non-emergency transportation and pharmaceuticals will apply to participants with temporary coverage. Pharmaceutical prior authorization requests may be submitted by telephone to 1-800-252-8942 or by telefax to 217-524-7264. Non-emergency transportation prior authorization requests may be submitted by telephone to 1-877-725-0569. There are no co-payments for children with temporary coverage. Providers will be reimbursed at the regular medical assistance rates with no deductions for co-payments.

Questions regarding this program should be directed to the Department of Human Services, Director of Contract Management/Child and Adolescent Services at 773-794-4872.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs