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Elizabeth M. Whitehorn, Director

Prior Approval for Trips to Group Psychotherapy

​To: Participating Non Emergency Transportation and Long Term Care Providers

Date: August 31, 2009

Re: Prior Approval for Trips to Group Psychotherapy
 

As a result of a recent administrative rule change to 89 Ill. Adm. Code 140.413(a)(4)(C), effective October 1, 2009, group psychotherapy services rendered by a physician, will be limited to 2 services (round trips) in a 7-day period.

First Transit Inc., the department's prior approval agent, will cancel all prior approvals including standing approvals, obtained for trips to group psychotherapy services on or after October 1, 2009. First Transit will re-issue the prior approvals through December 31, 2009, limiting the approvals to 2 round trips in a 7-day period. Providers will be responsible for submitting new prior approval requests for trips on or after January 1, 2010. This rule change does not affect trips to group psychotherapy services billed through community mental health centers or federally qualified health centers.

This rulemaking also contains new physician credential requirements that must be met in order for group psychotherapy to be considered a covered medical service. Beginning January 1, 2010, the entire group psychotherapy service must be directly performed by a physician who is licensed to practice medicine in all its branches and has completed an approved general psychiatry residency program or is providing the service as a resident or attending physician at an approved or accredited residency program. The department issued an informational notice dated April 28, 2009 with a May 12, 2009 addendum regarding Psychiatric Residency Certification Requirement located on the department's Web page at:<http://hfs.illinois.gov/physicians/>.

Questions regarding prior approvals should be directed to First Transit Inc. at 1-866-503-9040. Questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565. Questions related to long term care should be directed to the Bureau of Long Term Care at 217-524-0372.
 

Theresa A. Eagleson, Administrator
Division of Medical Programs