Provider Notice issued 06/25/04

Screening, Assessment and Support Services (SASS) Program

This statewide initiative will: (1) provide screening, assessment and treatment of any child or adolescent 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 or adolescent.

The purpose of this notice is to explain the various policies and procedures for this program and to provide information on fee-for-service billing training DPA will be conducting in July.

The SASS program has two components: (1) A Crisis and Referral Entry Services phone line known as CARES that operates through a 1-800 phone line, and (2) geographically dispersed screening agents known as SASS providers. The handbook for Providers of Screening, Assessment and Support Services (CMH-200) can be accessed on DPA’s Web site at <http://www.dpaillinois.com/handbooks/>

Target Populations

There are three target populations for the SASS program: (1) all children and adolescents under the age of 21 for whom DCFS is legally responsible; (2) children and adolescents under the age of 18 for whom DHS has been requested to pay for their hospitalization; and (3) children and adolescents under the age of 21 enrolled in DPA’s Medical Programs including KidCare.

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

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 CARES at 1-800-345-9049, TTY 1- 800-905-9645, seven days a week, 24-hours a day.

Providers who believe a child or adolescent is experiencing a mental health crisis and is at risk for a psychiatric hospitalization must contact CARES at the numbers listed above. 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. 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 community mental health provider must be reported by the SASS provider to CARES for registration and prior approval. For children and adolescents with a MediPlan or KidCare card, all regular Medical Programs payment policies apply. Pharmacy and transportation benefits are subject to existing prior approval policy. They do not require authorization by the SASS provider.

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 are areas designated by DHS and DCFS to facilitate the delivery and coordination of mental health services. SASS providers serving LANs along the Illinois borders, are also required to serve Illinois children and adolescents in other states’ counties contiguous to Illinois. A listing of these providers will be posted to DPA’s Web site before July 1, 2004 at the following link: <http://www.dpaillinois.com/cmh/>.

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

SASS for Children and Adolescents Without a MediPlan or KidCare Card ― Special Eligibility

If a child or adolescent, 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 DPA’s Web site prior to July 1 st at the following link: <http://www.dpaillinois.com/cmh/>.

Children and adolescents with temporary coverage are eligible only for services authorized through CARES, transportation to and from these services and certain classes of pharmaceuticals. A listing of pharmaceuticals covered for children and adolescents with temporary eligibility is posted on DPA’s Web site at the following link: <http://www.dpaillinois.com/cmh/>.

DPA prior authorization requirements for non-emergency transportation and pharmaceuticals will apply to participants with temporary eligibility. 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. Participant co-payments should not be assessed during the temporary eligibility period. Providers will be reimbursed at the regular medical assistance rates with no deductions for co-payments.

Fee-for-Service Billing

During July, DPA will conduct training on fee-for-service billing at four locations throughout the state. The training schedule is attached to this notice. As indicated on the schedule, we are requesting that providers call to register for a training session. If the requested session is full, you will be assigned to another session.

Questions should be directed to the following areas:

• General questions on the SASS program can be sent electronically to SASS@mail.idpa.state.il.us or you may call 217-524-7110.
  
• For providers who do not have Internet access, to obtain copies of the material referenced in this notice, please contact the Bureau of Comprehensive Health Services, Policy and Program Development Section at 217-524-7143.

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