​Date:   July 12, 2018                                                             

To:     All Medical Assistance Providers

Re:     New Provider Type – Behavioral Health Clinics (BHCs)

______________________________________________________________________

This notice is to inform providers of recent revisions to 89 Ill. Admin. Code 140 that established a new Medical Assistance Program Provider, Behavioral Health Clinics (BHCs).

BHCs must demonstrate compliance with the requirements outlined in 89 Ill. Admin. Code 140.499 and 140.Table O, including operating under the direction of a full-time Licensed Practitioner of the Healing Arts (LPHA) and ensuring sufficient staff to accommodate the services and populations to be served. Additional Department policies and procedures for participating BHCs will be outlined in a forthcoming Handbook for Providers of Community-Based Behavioral Health Services.

Participating BHCs may provide all of the Medicaid Rehabilitation Option – Mental Health and Targeted Case Management services identified in 89 Ill. Admin. Code 140.453, except BHCs will not be qualified to provide Assertive Community Treatment (ACT) and Psychosocial Rehabilitation (PSR). Additional details regarding the specific services and billing codes available to participating BHCs can be found in the Fee Schedule for Providers of Community-Based Behavioral Health Services.

BHC Provider Enrollment

Providers seeking to be recognized as a BHC must first enroll through the provider enrollment system, IMPACT. Providers may begin seeking BHC enrollment through IMPACT on or after July 16, 2018.

During the IMPACT enrollment process, providers will need to select the appropriate required Specialty/Subspecialty combinations based on the services they intend to provide at the specific location the provider is seeking to enroll. The following table is offered to assist BHCs in determining the most appropriate IMPACT enrollment profile:

E-mail: hfs.webmaster@illinois.gov                                  Internet: http://www.hfs.illinois.gov/

*Specialty/Subspecialty requires program approval or Department approval.

**While the structure of the BHC does not require a physician, the delivery of this service does require appropriately licensed staff.

BHCs authorized under any Subspecialty listed above may provide all of the corresponding services pursuant to Department policies and procedures.

BHC Administrative Review

Following completion of the IMPACT process, HFS will request, via email, the submission of additional administrative materials as required in 89 Ill. Admin. Code 140.Table O. These materials will be reviewed prior to the enrollment being approved and will include the following:

140.Table O a)2) - Operating policies and procedures that describe how the provider operates its programs and delivers services. An organizational chart must also be provided that outlines decision-making authority within the programs;

140.Table O a)3) - Policies and procedures must clearly reflect the provider’s compliance with the national Culturally and Linguistically Appropriate Standards (CLAS), as detailed by the Department of Health and Human Services Office of Minority Health;

140.Table O a)4) - Policies, protocols, and other necessary contracts or agreements to ensure individuals can access and maintain active support from an independent practitioner licensed by the State of Illinois to provide consultation, evaluation, prescription and management of medication;

140.Table O b)3) - Policies and procedures specific to emergency disaster plans, fire evacuation plans, and procedures for managing the basic maintenance of the site;

140.Table O b)7) - Current letter from the Office of the State Fire Marshal or the local fire authority demonstrating annual compliance with 41 Ill. Admin. Code Part 100;

140.Table O c)1) – List of Medicaid Rehabilitation Option services included in Rule 140 that the provider intends to provide along with a personnel list that shows properly credentialed staff are employed, as required for each of the services;

140.Table O c)2) - Employ a full-time Clinical Director who meets the requirements of a LPHA to oversee and direct the clinical functions of the BHC;

140.Table O d)1) – Documentation of current insurance against professional and physical liabilities;

140.Table O e)1) - Policies and procedures related to staff expectations for contacting primary care physicians (PCPs) and appropriate managed care staff, and procedures for documentation of those contacts;

140.Table O e)2)A) – Indication of business hours, and policies for after hours and weekend sessions, etc., along with policies regarding services provided in clients' homes, etc.; and,

140.Table O e)3) - Policy and procedures specifically related to the referral process for substance use disorder services;

Providers who are currently certified as a CMHC and who are seeking to transition their site to a BHC will be granted a one-time grace period and be immediately converted into a BHC. Providers seeking to convert from a CMHC to a BHC will have the initial BHC administrative review waived if the provider’s CMHC certification is in good standing (meaning a Certification Level I or Level II) with their certifying agency.

Please note that certain services may be subject to additional program approval, as required and outlined in 89 Ill. Admin. Code 140.Table N. Program approval review will focus on overall quality of service delivery and outcomes realized for HFS-enrolled individuals served by the BHC in the specialty program.

BHC Technical Parameters

BHC will appear in the HFS MMIS system with the following technical parameters:

Provider Type Name:     Behavioral Health Clinic (BHC)

Provider Type Code:     027

Category of Service:      116

Specialty Codes:            IOP (Intensive Outpatient)

CST (Community Support Team); MCR (Mobile Crisis Response STA (Crisis Stabilization)

Taxonomy Code:           261QM0850X – Adult Mental Health Clinic; or

261QM0855X – Adolescent and Children Mental Health Clinic

Claim Type:                    837P

Questions regarding this notice may be directed to the Bureau of Behavioral Health via telephone at 217-557-1000 or via email at HFS.CBH@illinois.gov.

Teresa T. Hursey
Interim Director