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Our new Child Support Cook Central Office at 115 South LaSalle Street, Chicago, is now open for in-person assistance.  We also have other regional office locations to better serve you! 

Elizabeth M. Whitehorn, Director

Provider Notice issued 09/04/2024

 

To:
 Enrolled Substance Use Prevention and Recovery (IDHS/SUPR) Providers
​Date September 4, 2024
​Re:
 Coverage of Peer Recovery Support Services per Public Act 102-1037 

This notice announces coverage of Peer Recovery Support (PRS) Services in accordance with Public Act 102-1037 effective for dates of service on or after October 1, 2024. These services will be covered in both the Illinois Medicaid fee-for-service (FFS) program and HealthChoice Illinois (HCI) managed care organizations (MCOs) for HFS-enrolled customers, when delivered by a provider licensed by the Illinois Department of Human Services’ Division of Substance Use Prevention and Recovery (IDHS/SUPR).

Service Definition

PRS services are nonclinical in nature, culturally responsive, and supportive of a customer’s treatment goals throughout all stages of the treatment and recovery process. PRS services are delivered person to person, aimed at increasing recovery capital by empowering individuals through strength-based coaching, supporting linkages to community resources and the development of natural supports, supporting engagement in treatment services, and educating customers and their families about the conditions and process of recovery. Services can include contact with family members or other collaterals if the purpose of the collateral’s participation is to focus on the needs of the customer by supporting the achievement of the customer’s recovery or treatment goals. PRS services may be delivered in-person or via telehealth (audio and or video).

Medical Necessity

PRS services are considered medically necessary when they are recommended by a physician for a customer with a diagnosed substance use disorder (SUD), as listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), that has a documented impact on the customer’s functioning in one or more life domain(s). Medical necessity for PRS services must be documented on the customer’s recovery or treatment plan and signed by the authorizing physician.

Staff Qualifications

PRS services are provided directly by a peer support worker, operating under the supervision of a qualified “professional staff” as defined in 77 Ill. Admin. Code 2060, and who meet all the following qualifications:

    ·Are at least 18 years of age.
    ·Have a minimum one year of recovery from substance use, mental health, or co-occurring substance use and mental health challenges. Certified by the Illinois Certification Board (ICB, Inc.) as a Certified Recovery Support Specialist (CRSS) or as a Certified Peer Recovery Specialist (CPRS) or be certified within one year of employment date.
    ·Demonstrates the ability to work within agency structure, accept supervision, and participate as a member of a multi-disciplinary team, when applicable.

Billing and Reimbursement

Reimbursement for PRS services is available for FFS and MCO claims. Eligible providers may seek reimbursement for PRS services by submitting HCPCS Code H2014 on the 837P claim format to the appropriate MCO. FFS claims must be submitted directly to SUPR through DARTS. All billable services are identified in the SUPR Fee Schedule.   

Questions regarding this notice may be directed to HFS.BBH@illinois.gov.

 

Kelly Cunningham, Administrator
Division of Medical Programs