Provider Notice issued 03/05/15

Clarification on Screening and Assessment Services Prior to Inpatient Psychiatric Admission for Youth Enrolled with a Managed Care Organization

This notice clarifies the responsibilities of Healthcare and Family Services (HFS) under Public Act 93-0495 (Children’s Mental Health Act of 2003) to ensure all Medicaid-eligible youth are screened and assessed prior to inpatient admission for psychiatric services. The Children’s Mental Health Act requires the Department to establish protocols for ensuring access to screening and assessment services for children and adolescents (individuals under the age of 21) prior to any Medicaid-funded admission to an inpatient hospital for psychiatric services.

Under the traditional Medicaid fee-for-service system, Care Coordination Entities (CCEs), and Accountable Care Entities (ACEs), children and adolescents are screened prior to an inpatient psychiatric admission by the Screening, Assessment and Support Services (SASS) program. The policies and procedures outlining this process can be in the Handbook for Hospital Services (pdf) and Handbook for Providers of Screening, Assessment and Support Services (pdf).

Medicaid-eligible individuals enrolled with an HFS contracted Managed Care Organization (MCO) or Managed Care Community Network (MCCN) are not eligible for the SASS program; however, this does not negate the MCO or the MCCN’s responsibility to require compliance with the Act. Each of the MCOs serving children and adolescents is developing a mobile crisis response system within its provider network to ensure the availability of screening and assessment services for individuals under the age of twenty-one (21) prior to an inpatient psychiatric admission.

To maintain compliance with Public Act 93-0495, it is imperative that inpatient providers work with the MCOs and MCCNs to understand their operational and prior approval processes for ensuring the screening of children and adolescents prior to inpatient psychiatric admission. Electronic Data Interchange vendors (formerly the Recipient Eligibility Verification (REV) System), the Automated Voice Response System (AVRS) at 1-800-842- 1461, and the Medical Electronic Data Interchange (MEDI) system will identify any care coordination plan in which the beneficiary is enrolled.

Any questions regarding this notice may be directed to the SASS Helpline at 217-557-1000.

James M. Parker, Acting Administrator

Division of Medical Programs