Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 141 - SOCIAL SERVICE FOR NON-WAIVER HOME AND COMMUNITY BASED SERVICES
Subpart B - CHILDREN'S MENTAL HEALTH HOME AND COMMUNITY-BASED SERVICES
Section 141.215 - Service Reimbursement

Current through Register Vol. 48, No. 38, September 20, 2024

a) The CMH-HCBS services detailed in Section 141.220 shall be eligible for reimbursement pursuant to the Department's published fee schedule when the services are rendered by a provider approved by the Department and are:

1) Recommended by a Licensed Practitioner of the Healing Arts (LPHA) in consultation with the participant's Child and Family Team (CFT), as applicable, on the participant's IATP;

2) Provided to a participant for the maximum reduction of mental disability and restoration to the best possible functional level;

3) Provided consistent with any service limitations, utilization controls, and prior authorizations established by the Department pursuant to 89 Ill. Adm. Code 140.40 or as detailed in this Part; and

4) Provided for the direct benefit of the participant, which may include support provided to immediate caregivers of the eligible participant.

b) Reimbursement for CMH-HCBS services shall not:

1) Be made for services provided to a participant at the same time as another service that is the same in nature and scope as the CMH-HCBS service, regardless of payer or program source, including Federal, state, local, and private entities;

2) Include special education and related services defined in the Individuals with Disabilities Education Improvement Act of 2004 (20 U.S.C. 1400 et seq.) that otherwise are available to the participant through a local education agency, or vocational rehabilitation services that otherwise are available to the individual through a program funded under section 110 of the federal Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.); and

3) Be made to relatives, legally responsible individuals, or legal guardians rendering services to the participant.

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