Provider Notice issued 07/05/07

 Transition of Service Definitions

 The purpose of this notice is to advise community mental health providers of changes to the mental health services reimbursable under the medical assistance programs administered by Healthcare and Family Services (HFS) and paid for by a public payer (a State or local government entity that has entered into an agreement with HFS to pay for such services). These changes have been the subject of training sessions provided by the Departments of Human Services and Children and Family Services over the past two months. These services are provided under the authority of the Title XIX and XXI State plans and implemented through 59 Ill. Adm. Code 132 and 89 Ill. Adm. Code 140.

Assertive Community Treatment (ACT) has been redefined to be consistent with nationally recognized evidence-based practice.

Two previously defined services, Therapeutic Behavioral Services and Skills Training and Development, have been subsumed under a newly defined service—Community Support (individual and group). The State departments are providing a three-month transition period for revising current treatment plans to reflect the new services. For the purpose of future program and financial audits of 59 Ill. Adm. Code 132 services, the documentation transition is defined as follows:

 

Providers who were certified for Therapeutic Behavioral Services or Skills Training and Development on June 30, 2007, are certified automatically for Community Support (individual and group) effective July 1, 2007, and may bill for Community Support (individual and group) to clients whose treatment plans indicate the provision of Therapeutic Behavioral Services or Skills Training and Development. No later than October 1, 2007, all treatment plans must be amended to include Community Support (individual and group), if applicable. All new treatment plans after June 30, 2007 must reflect the new services.

Except as noted above with respect to the transition period for documentation requirements for Community Support (individual and group), all requirements are effective July 1, 2007. The Community Mental Health Services, Service Definition and Reimbursement Guide (previously known as the “crosswalk”) has been updated to reflect all new services. This guide may be found on the Internet at: http://www.hfs.illinois.gov/reimbursement/

 

Questions regarding this notice should be directed to the State agency (Department of Human Services, Department of Children and Family Services or Department of Corrections) that has certified your agency for participation in the 59 Ill. Adm. Code 132 mental health services program.

Theresa A. Eagleson, Administrator

Division of Medical Programs