Illinois Administrative Code
Title 59 - MENTAL HEALTH
Part 131 - CHILDREN'S MENTAL HEALTH SCREENING, ASSESSMENT AND SUPPORT SERVICES PROGRAM
Section 131.50 - Program Services
Universal Citation: 59 IL Admin Code ยง 131.50
Current through Register Vol. 48, No. 28, July 12, 2024
a) Community Mental Health Services
1) Children,
as a result of the mental health screening required under Section
131.40, for
whom it has been determined by a SASS agent that appropriate alternative
resources are available in the community shall be referred to those services by
the SASS agent. Community mental health services (CMHS) shall be reimbursed by
HFS, DCFS or DHS only under the following conditions:
A) The CMHS provider is enrolled with the HFS
to participate in the Illinois medical assistance program and meets the
requirements for certification and payment under 59 Ill. Adm. Code
132.
B) The CMHS provider is one of
the following:
i) The SASS agent to which
responsibility for managing the child's care was assigned by CARES.
ii) Another CMHS provider that, through
CARES, is authorized to provide CMHS to children.
C) The service is provided in accordance with
the plan of care developed by the SASS agent.
D) The service is provided during the SASS
period.
E) The patient was a child
at the time of screening and met eligibility requirements specified in Section
131.30(c).
2) Payment shall be made utilizing
rates of reimbursement established under 59 Ill. Adm. Code 132.
b) Pharmacy Services
1) DHS shall pay for certain prescribed drugs
dispensed to a child who meets DHS eligibility requirements in Section
131.30(c).
Pharmacy services, other than those provided by an inpatient psychiatric
facility, shall be reimbursed only under the following conditions:
A) The pharmacy provider is enrolled with HFS
to participate in the Illinois medical assistance program.
B) The service is provided in accordance with
the plan of care developed by the SASS agent.
C) The service was provided during the SASS
period.
D) The patient was a child
at the time of screening.
E) The
prescribed drug has been determined by DHS/DMH as appropriate for the treatment
of serious emotional disturbance or mental illness or related
symptoms.
2) Payment
shall be made utilizing rates of reimbursement established under the provisions
of 89 Ill. Adm. Code
140.444
and
140.445.
c) Transportation Services
1) DHS shall pay for certain emergency and
non-emergency transportation services provided to a child who meets DHS
eligibility criteria specified in Section
131.30(c).
Transportation services, other than those provided by an inpatient psychiatric
facility, shall be reimbursed only under the following conditions:
A) The transportation provider is enrolled
with HFS to participate in the Illinois medical assistance program.
B) The transportation is in support of the
plan of care developed by the SASS agent and is to or from a source of medical
care covered under this Part.
C)
The service was provided during the SASS period.
D) The patient was a child at the time of
screening.
2) Payment
shall be made utilizing rates of reimbursement established under 89 Ill. Adm.
Code
140.492
and
140.493.
d) Inpatient Psychiatric Services
1) DHS shall pay for certain inpatient
psychiatric services provided to a child who meets DHS eligibility criteria
specified in Section
131.30(c).
Inpatient psychiatric services, other than those provided by an inpatient
psychiatric facility operated by DHS, shall be reimbursed only under the
following conditions:
A) The inpatient
facility is enrolled with HFS to participate in the Illinois medical assistance
program and meets the special requirements for inpatient psychiatric services
found at 89 Ill. Adm. Code
148.40(a).
B) Prior to admission, the individual shall
be screened by a SASS agent to determine the appropriateness of an inpatient
admission and the availability of alternative treatment resources in the
community.
C) The admission is
approved by DHS or its agent.
D)
Prior to discharge, the SASS agent participated in the development of the
discharge plan.
E) The date of
admission was during the SASS period.
F) The patient was a child at the time of
admission.
2) Payment
shall be made utilizing rates of reimbursement established for the medical
assistance program under 89 Ill. Adm. Code
148.270
and 89 Ill. Adm. Code
152.200,
subject to utilization review or pre- or post-payment reviews, as
applicable.
e) Psychiatric Physician Services
A child eligible for psychiatric physician services must be currently enrolled in a SASS program and must meet the requirements under Section 131.30(c)(1) and (2).
1) Physician services shall be reimbursed
only under the following conditions:
A) The
physician is enrolled with HFS to participate in the Illinois Medical
Assistance Program.
B) The service
is one of the following:
i) Psychiatric
diagnostic interview examination inpatient and outpatient by a SASS staff
psychiatrist;
ii) Electroconvulsive
therapy (includes necessary monitoring), single and multiple seizures per day.
Electroconvulsive therapy must have prior approval from DHS;
iii) Individual psychotherapy, insight
oriented behavior modifying and/or supportive that is approximately 20-80
minutes face to face with the patient with medical evaluation and management
services provided in a hospital inpatient setting only, during an inpatient
psychiatric stay; or
iv) Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, approximately
20-80 minutes face to face with the patient with medical evaluation and
management services.
C)
The service was provided during the SASS period.
D) The patient was a child at the time of
screening.
2) Payment
shall be made utilizing rates of reimbursement established under the provisions
of 89 Ill. Adm. Code
140.410 through
140.414.
Disclaimer: These regulations may not be the most recent version. Illinois may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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