Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 140 - MEDICAL PAYMENT
Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES
Section 140.453 - Community-based Mental Health Service Definitions and Professional Qualifications

i) Successfully completed 1,000 hours of practicum and/or internship under clinical and educational supervision; or

ii) One year of documented clinical experience under the supervision of a QMHP.

i) Any individual identified as a QMHP in subsection (b)(4); or

ii) An individual meeting the following qualifications, delivering services under the supervision of a QMHP:

* An individual possessing a bachelor's degree in counseling and guidance, rehabilitation counseling, social work, education, vocational counseling, psychology, pastoral counseling, family therapy, or related human service field;

* An individual possessing a bachelor's degree in any field, other than those identified in subsection (b)(4)(D), with two years of documented clinical experience in a mental health setting under the supervision of a QMHP;

* A practical nurse who holds a valid license in the state of practice and is legally authorized under state law or rule to practice as a practical nurse, so long as that practice is not in conflict with the Illinois Nurse Practice Act;

* An individual possessing a certificate of psychiatric rehabilitation from a DHS-approved program, plus a high school diploma or GED, plus two years' documented experience in providing mental health services;

* A recovery support specialist with a current certification from the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc.;

* A family partnership professional with current certification from the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc.;

* An occupational therapy assistant with at least one year of experience in a mental health setting that holds a valid license in the state of practice and is legally authorized under state law or rule to practice as an occupational therapist assistant, so long as that practice is not in conflict with the Illinois Occupational Therapy Practice Act. In the event the state of practice does not provide a legal authority for licensure, the individual must meet the requirements of 42 CFR 484.4 for an occupational therapist; or

* An individual with a high school diploma or GED and a minimum of five years documented clinical experience in mental health or human services.

* An individual who has completed a behavioral health technician or other psychiatric training certification through the Medical Education and Training Campus in Fort Sam Houston, Texas, with one year documented clinical experience in a mental health setting under supervision of a QMHP.

i) Any individual identified as an MHP in subsection (b)(5);

ii) Any individual who is 21 years of age and demonstrates all of the following:

* Skill in the delivery of rehabilitative services to adults or children;

* The ability to work within a provider agency's structure and accept supervision; and

* The ability to work constructively with individuals receiving services, other providers of service, and the community; or,

iii) An individual qualified as a PSW pursuant to subsection (b)(7).

i) Be completed once every 180 days;

ii) Only be reimbursed upon utilization of a Department approved assessment and service planning instrument as published on the Department's website;

iii) Be reviewed, approved and signed by an LPHA;

iv) Be provided to the client, or the client's parent or guardian, upon completion or revision.

i) Clinical assessment activities, performed by, or under the supervision of, an LPHA using a nationally standardized assessment instrument resulting in a written report or documented outcome that includes the identification of a clinical issue or tentative diagnosis to assist in the completion of IATP;

ii) Diagnostic assessment activities, only when provided consistent with the Clinical Psychologist Licensing Act [225 ILCS 15 ] and using a nationally standardized psychological assessment instrument, resulting in a written report that includes the identification of issues, tentative diagnosis, and recommendations for treatment or services; and

iii) The completion of the Level of Care Utilization System (LOCUS) screen, or its successor instrument.

i) By Community Mental Health Centers, Behavioral Health Clinics, or Independent Practitioners;

ii) At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

iii) On an individual basis;

iv) By an MHP, QMHP, LPHA; and

v) By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403.

i) Community Support Services includes: engaging the individual to have input into his/her service delivery and recovery process; development of relapse prevention strategies and plans; assistance in development of functional, interpersonal and community coping skills (including adaptation to home, school, family and work environments); and skill-building related to symptom self-monitoring. Community Support Services may include an evidence-informed approach to skills training.

ii) Community Support Services may only be provided:

* By a Community Mental Health Center or Behavioral Health Clinic;

* At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

* In an individual or group modality;

* By an RSA, MHP, QMHP, LPHA; and

* By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.40 3.

i) IO Services may only be provided:

* By a Community Mental Health Center or Behavioral Health Clinic;

* Through programs approved pursuant to Table N;

* At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

* By a QMHP;

* In a group modality; and

* On a face-to-face basis.

ii) IO services may be subject to prior authorization, pursuant to Section 140.40.

i) By a Community Mental Health Center or Behavioral Health Clinic;

ii) At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

iii) On an individual basis;

iv) By face-to-face contact; and

v) By staff that hold a valid license in the state of practice and are legally authorized under state law or rule to administer medication, so long as that practice is not in conflict with the Illinois Nurse Practice Act or the Medical Practice Act of 1987 (e.g., a physician, a psychiatrist, advanced practice nurse, registered nurse or a practical nurse).

i) By a Community Mental Health Center or Behavioral Health Clinic;

ii) At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

iii) On an individual basis;

iv) By an RSA, MHP, QMHP or LPHA, as designated in writing to provide the service by staff that hold a valid license in the state of practice and are legally authorized under state law to prescribe medication pursuant to the Illinois Nurse Practice Act or the Medical Practice Act of 1987; and

v) By video or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403. Phone consultation is allowed only when a client is experiencing adverse symptoms and phone consultation with another professional is necessary.

i) By a Community Mental Health Center or Behavioral Health Clinic;

ii) At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

iii) In an individual or group modality;

iv) By video or face-to-face contact; and

v) By an RSA, MHP, QMHP or LPHA, as designated in writing to provide the service by staff that hold a valid license in the state of practice and are legally authorized under state law to prescribe medication pursuant to the Illinois Nurse Practice Act or the Medical Practice Act of 1987.

i) PSR services may only be provided:

* On-site at a Community Mental Health Center;

* Through a program that is approved pursuant to Table N;

* In an individual or group modality. The staffing ratio for groups shall not exceed one full-time equivalent staff to 15 individuals;

* By an RSA, MHP, QMHP and LPHA; and

* By face-to-face contact.

ii) PSR may be subject to prior authorization, pursuant to Section 140.40.

i) By a Community Mental Health Center, Behavioral Health Clinic, or Independent Practitioner;

ii) At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

iii) In an individual, group or family modality;

iv) By an MHP, QMHP and LPHA; and

v) By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403.

i) Crisis Intervention. Crisis Intervention is short-term intervention for clients who, in the course of treatment or intervention, appear to need immediate intensive intervention to achieve crisis symptom reduction and stabilization. Crisis Intervention shall be provided:

* By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Section 140.6(n) and 140.403; and

* By a QMHP, LPHA or MHP with immediate access to a QMHP.

ii) Mobile Crisis Response (MCR). MCR is a mobile, responding to the location of the client, intervention seeking to achieve crisis symptom reduction, stabilization, and restoration of the client to a previous level of functioning, establishing support for the client's caregivers when applicable, mitigating the crisis event. MCR activities are tailored to the needs of the client, require face-to-face crisis screening, and may include: short-term intervention; crisis safety planning; brief counseling; consultation with other qualified providers to assist with the client's specific crisis; referral and linkage to community services; and, in the event that the client cannot be stabilized in the community, facilitation of a safe transition to a higher level of care. MCR shall be provided:

* By a provider certified by the Department to provide MRO Crisis Services pursuant to Table N;

* On a face-to-face basis;

* By a crisis team trained in crisis de-escalation techniques, led by a QMHP, LPHA or MHP with immediate access to a QMHP and at least one other individual meeting any of the qualifications detailed in subsection (b); and

* Utilizing a Department approved crisis screening instrument available on the Department's website.

iii) Crisis Stabilization. Crisis Stabilization services are available immediately following an MCR event and are designed to prevent additional behavioral health crises from occurring by providing strengths-based, individualized, direct supports on a one-on-one basis to clients in the home or community setting. Crisis Stabilization services shall be provided:

* By a provider certified by the Department to provide MRO Crisis Services pursuant to Table N;

* Upon demonstrated need for stabilizing supports as documented in the client's Crisis Safety Plan following the review, approval, and signature by an LPHA. The Crisis Safety Plan contains an identification of diagnosis, need or functional impairment; a treatment recommendation of Crisis Stabilization service accompanied by a recommendation for service amount, frequency and duration; and documentation of the entity responsible for service delivery;

* On a face-to-face basis; and

* By an MHP, with immediate access to a QMHP, trained in crisis intervention techniques.

i) ACT Services shall be:

* Provided only by Community Mental Health Centers;

* At least one member of the team who is either a Certified Recovery Support Specialist (CRSS) or Certified Family Partnership Professional (CFPP), based upon the age of the clients served by the team. A person with lived experience may be included on a team that does not have a CRSS or CFPP if he/she obtains certification within 18 months after his/her date of hire; and

* Available 24 hours per day, seven days a week, each week of the year.

ii) ACT Services may only be provided:

* To eligible individuals age 18 or older;

* At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

* In an individual or group modality; and

* By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403.

iii) ACT Services may be subject to prior authorization, pursuant to Section 140.40.

iv) ACT Services shall be delivered by a team led by a full-time:

* LPHA;

* Licensed social worker (LSW) possessing at least a master's degree in social work, who holds a valid license in the state of practice and is legally authorized under that state's law or rule to practice as an LSW so long as that practice is not in conflict with the Clinical Social Work and Social Work Practice Act [225 ILCS 20 ] and who has specialized training in mental health services, or with at least two years experience in mental health services;

* Licensed professional counselor possessing at least a master's degree, who holds a valid license in the state of practice and is legally authorized under that state's law or rule to practice as a licensed professional counselor so long as that practice is not in conflict with the Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107 ] and who has specialized training in mental health services, or with at least two years experience in mental health services;

* Registered nurse (RN) who holds a valid license in the state of practice and is legally authorized under that state's law or rule to practice as a RN, so long as that practice is not in conflict with the Nursing and Advanced Practice Nursing Act [225 ILCS 65 ], and who has at least one year of clinical experience in a mental health setting or a master's degree in psychiatric nursing; or

* Occupational therapist (OT) who holds a valid license in the state of practice, is legally authorized under that state's law or rule to practice as an OT, so long as that practice is not in conflict with the Illinois Occupational Therapy Practice Act [225 ILCS 75 ] and who has at least one year of clinical experience in a mental health setting.

i) CST Services shall be:

* Provided only by programs approved pursuant to Table N;

* Delivered by a team led by a full-time QMHP; and

* Available 24 hours per day, seven days a week, each week of the year.

ii) CST Services may only be provided:

* By a Community Mental Health Center or Behavioral Health Clinic;

* At all service locations and setting deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

* On an individual basis;

* By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403.

iii) CST Services may be subject to prior authorization, pursuant to Section 140.40.

i) VP-CST services must be delivered:

* Consistent with the fidelity requirements outlined in the Department's provider handbook for community-based behavioral health and available on the Department's website;

* By a Community Mental Health Center or Behavioral Health Clinic that has been approved to deliver VP-CST pursuant to Table N;

* By a team overseen by a full-time QMHP;

* By staff who meet the qualifications of a PSW, RSA, MHP, QMHP, or LPHA;

* In an individual, group, or family modality;

* By video, phone, or face-to-face contact, notwithstanding the restriction on services provided via phone in 89 Ill. Adm. Code 140.6(m) and 140.403;

* At a service location and setting deemed appropriate for reimbursement, as detailed in the Department's published fee schedule; and

* Available 24 hours per day, seven days a week, each week of the year.

ii) VP-CST services may be subject to prior authorization, pursuant to Section 140.40.

i) To eligible individuals receiving one or more services detailed in Section 140.453(d)(2) (General MRO Services);

ii) By a Community Mental Health Center or Behavioral Health Clinic;

iii) At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

iv) On an individual basis;

v) By an RSA, MHP, QMHP and LPHA; and

vi) By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403.

i) For 30 days prior to completion of the Integrated Assessment and Treatment Plan;

ii) By a Community Mental Health Center or Behavioral Health Clinic;

iii) At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

iv) On an individual basis;

v) By an RSA, MHP, QMHP and LPHA; and

vi) By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403.

i) Transition, Linkage and Aftercare Limitation. The Department will not fund more than 40 hours of this service per State fiscal year for an eligible individual.

ii) Transition, Linkage and Aftercare may only be provided:

* By a Community Mental Health Center or Behavioral Health Clinic;

* At all service locations and settings deemed appropriate for reimbursement, as detailed in the Department's published fee schedule;

* On an individual basis;

* By an MHP, QMHP and LPHA; and

* By video, phone or face-to-face contact, notwithstanding the restriction on services provided via phone in Sections 140.6(n) and 140.403.

iii) Transition Linkage and Aftercare Case Management Services may be subject to prior authorization, pursuant to Section 140.40.