Provider Notice issued 07/10/06

Payment for Children’s Mental Health Program Services

Filing of application. DHS funds services for SASS-enrolled children and adolescents who are (1) not enrolled in one of the HFS medical assistance programs and (2) do not have private insurance at the time they are enrolled in the SASS program. If a child has been hospitalized as part of the SASS intervention, it is the hospital’s responsibility to assist and ensure that an application has been filed prior to the end of the hospitalization. If the child is receiving community mental health services only, the SASS agency, or other CMH provider rendering services to the child, is responsible for assisting and ensuring that an application has been filed.

SASS agencies and other CMH providers may ensure reimbursement for services provided after the initial 24 hours of enrollment under the SASS program, by assisting these children and their families in applying for medical assistance. Providers enrolled as All Kids Application Agents (AKAAs), previously called KidCare Application Agents, will receive a $50 Technical Assistance Payment (TAP) for each complete application that results in new coverage. A complete application is one where all items of the “Checklist and Technical Assistance Payment Request” form for paper applications or the “AKAA Fax” for electronic applications, have been completed. Means of documenting the application process varies depending upon whether or not the application is submitted in hardcopy paper format or electronically.

The attached document provides information on the application processes for AKAAs. Providers interested in enrolling as an AKAA can find the information on the Web site at: http://www.allkidscovered.com/akaa/apply.html

Select coverage under one of the medical assistance programs administered by Healthcare and Family Services (e.g., Medicaid, All Kids and Family Assist) may be retroactively applied to the beginning of the third month prior to filing the application. It is recommended that all applicants request retroactive coverage at the time the application is completed. By requesting retroactive eligibility, the child may receive full medical benefits for any outstanding services in that time period. Please note eligibility under the All Kids Premium Levels 2 through 8 cannot be backdated.

Temporary All Kids coverage. Children and adolescents can get immediate coverage (Temporary All Kids coverage does not apply to All Kids Premium Levels 2 through 8) while their application is being reviewed if all of the following are true:

• They are U.S. citizens or meet immigration requirements.

• They have not gotten Temporary All Kids in the past 12 months.
• Their monthly family income is no more than the amounts shown in the chart below.

Please note, these are the current income standards, and may be subject to change. Refer to the All Kids Web site at http://www.allkidscovered.com/pe.html for updated information.

This coverage is in effect on the date that the application for medical assistance is received by a DHS local office or the HFS All Kids office. Answers to frequently asked questions regarding temporary coverage can be found on the Internet at <http://www.allkidscovered.com/pe.html>.

Exception. In those instances where a family is unable, or refuses, to apply for medical assistance, or if the SASS agency or other CMH provider finds it impossible to assist the family in applying, a request for an exception to the application eligibility requirement may be made by contacting the DHS Children and Adolescent Services unit. The SASS agency or the CMH provider should inform families that if they refuse to file an application, and an exception is not granted, the family can be billed for the services. By filing a complete application, regardless of the application outcome, the family will not be financially responsible for the SASS services.

Requests for an exception can be made by calling 773-794-4875. The following information will be required at the time the exception request is made: (1) the SASS agency or CMH provider’s name and HFS provider ID number; (2) the child’s name, date of birth, recipient identification number (RIN); (3) the date of initial service; (4) the reason for exception and; (5) a SASS agency or CMH provider contact person and telephone number. DHS will notify the SASS agency or the CMH provider by telephone on the outcome of the review within one business day of the request being made. In addition, the provider will receive written notification of the review outcome within 10 business days.

Processing of claims. Services rendered after the initial 24 hours of enrollment in SASS will be subject to a special review process. This process does not apply to services rendered on the first day of eligibility.

Effective with dates of service on and after July 1, 2006, for claims submitted on DHS funded children, individual service sections with dates of service after the initial 24 hours of enrollment in the SASS program will be reported to the provider on a remittance advice as “Suspended for Department Review.” Once DHS determines that a complete application has been submitted for the child, or an exception has been granted by DHS, HFS will be notified to release the claim for processing. Providers will receive a subsequent remittance advice reporting the final disposition of the claim.

If no application is filed, and no exception is granted, then only services rendered on the initial SASS eligibility date will be paid. All other services will reject with error code A77 – No Medicaid Application Was Filed.

Any questions regarding this notice may be directed to the DHS Children and Adolescent Services unit at 773-794-4875.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs

Payment for Children’s Mental Health Program Services (pdf)