Community-Based Behavioral Services (CBS) Provider Handbook

Community-Based Behavioral Services(CBS)Provider HandbookIllinois Department of Healthcare and Family ServicesEffective October 1, 2018

Provider Specific PoliciesCommunity-Based BehavioralServices Provider HandbookPage 2Date:October 1, 2018Revision HistoryDatePolicies and procedures as ofOctober 1, 2018Published: October 19, 2018Reason for RevisionsNew document

Provider Specific PoliciesCommunity-Based BehavioralServices Provider HandbookPage 3Date:October 1, 2018Community-Based Behavioral ServicesProvider Handbook Table of Contents201Basic Provisions . 202.10.2Provider Participation . 6IP Enrollment. 6CMHC Enrollment . 6CMHC Certification . 8BHC Enrollment . 8BHC Approval Process . 9Program Approval Process . 9Program Approval Review Components . 10Assertive Community Treatment Review . 11On-Site Reviews . 11Prohibition on Co-Location . 11National Provider Identification (NPI) Number. 12Transfer of Ownership . 12Participation Approval . 12Participation Denial . 12Provider File Maintenance. 12Provider Responsibility . 13HFS Responsibility. 13203203.1Record Requirements . 14Monitoring Activities . 4.3.5Provider Reimbursement. 15Charges. 15Payment and Reimbursement . 15Payers of MRO-MH and TCM Services. 15Funding from HFS. 15Funding from DHS-DMH . 15Funding from DCFS . 16Funding for the Screening, Assessment and Support Services Program . 16Funding from Managed Care Plans . 16205Covered Services . 17206Non-Covered Services . 17207207.1207.1.1207.1.2Billing and Service Delivery Requirements . 18General Medical Necessity Requirements . 18Integrated Assessment and Treatment Planning (IATP) . 18Medical Necessity Requirements for Specific Services . 19

Provider Specific PoliciesCommunity-Based BehavioralServices Provider HandbookPage 4Date:September 19, 1Utilization Management . 19Claiming Requirements . 20Billing NPI . 20Rendering Provider . 20Reporting the Diagnosis Code for Participants under Age 21 . 20Reporting Place of Service . 20Guidance on Selecting the Appropriate POS . .19208.4.20208.3208.3.1208.3.2208.3.3Service Guidance and Coding Structure. 23General Notes . 23Notes on the Structure of the Services Section . 23Group A Services . 24Integrated Assessment and Treatment Planning (IATP) . 24IATP: Psychological Assessment. 25IATP: Level of Care Utilization System (LOCUS). 26Crisis Intervention . 27Therapy/Counseling . 27Group B Services . 28Community Support . 28Medication Administration . 29Medication Monitoring . 29Medication Training. 30Client-Centered Consultation Case Management . 31Mental Health Case Management. 32Transition, Linkage and Aftercare Case Management . 33Crisis Intervention – Team . 34Crisis Stabilization. 35Mobile Crisis Response . 35Community Support Team . 36Intensive Outpatient . 37Developmental Screening . 38Developmental Testing . 38Mental Health Risk Assessment . 39Prenatal Care At-Risk Assessment . 39FSP: Application Assistance . 40FSP: Case Participation . 41FSP: Family Support Services . 41FSP: Therapeutic Support Services . 42Group C Services . 42Telepsychiatry: Originating Site . 42Assertive Community Treatment . 43Psychosocial Rehabilitation . 44

Provider Specific PoliciesCommunity-Based BehavioralServices Provider Handbook201Page 5Date:September 19, 2018Basic ProvisionsThis handbook has been prepared for the information and guidance of providers whoprovide Medicaid Rehabilitation Option – Mental Health (MRO-MH) and Targeted CaseManagement (TCM) services, as detailed in 89 Ill. Admin. Code 140.453, to participants inthe Department’s Medical Programs. It also provides information on the Department’srequirements for provider participation and enrollment.It is important that both the provider of service and the provider’s billing personnel read allmaterials prior to initiating services to ensure a thorough understanding of the Department’sMedical Programs policy and billing procedures. Revisions in and supplements to thehandbook will be released from time to time as operating experience and state or federalregulations require policy and procedure changes in the Department’s Medical Programs.The updates will be posted to the Department’s website on the Provider Notices page.Providers wishing to receive e-mail notification when new provider information has beenposted by the Department may register on the website.Services provided must be in full compliance with both the general provisions contained inthe Handbook for Providers of Medical Services, General Policy and Procedures, and thepolicy and procedures contained in this handbook. Exclusions and limitations are identifiedin specific topics contained herein. Providers submitting X12 837P electronic transactionsmust also refer to the Handbook for Electronic Processing. The Handbook for ElectronicProcessing identifies information specific to conducting Electronic Data Interchange (EDI)with the Illinois Medical Assistance Program and other health care programs funded oradministered by the Department.Providers should always verify a participant’s eligibility before providing services, both todetermine eligibility for the current date and to discover any limitations to the participant’scoverage. It is imperative that providers check HFS electronic eligibility systems regularly todetermine eligibility. The Recipient Eligibility Verification (REV) System, the AutomatedVoice Response System (AVRS) at 1-800-842-1461 and the Medical Electronic DataInterchange (MEDI) systems are available.Unless otherwise specified, the billing instructions contained within this handbook apply toparticipants enrolled in the Department’s traditional fee-for-service programs and do notnecessarily apply to participants enrolled in a HealthChoice Illinois managed care healthplan.Inquiries regarding coverage of a particular service or billing issues may be directed to theBureau of Professional and Ancillary Services at 1-877-782-5565. Questions regarding thepolicies or service requirements outlined within this Handbook may be directed to theBureau of Behavioral Health at 217-557-1000 or HFS.BHCompliance@illinois.gov.NOTE: Previous rate schedules and provider manuals for community behavioral healthproviders have been titled, “Service Matrix”, “Crosswalk”, and/or “Service Definition andReimbursement Guide” – this guide replaces all other existing documents as the officialHandbook for Providers of Community-Based Behavioral Services.

Provider Specific PoliciesCommunity-Based BehavioralServices Provider Handbook202Page 6Date:October 1, 2018Provider ParticipationAny provider seeking reimbursement for the MRO-MH or TCM services must be enrolled forparticipation in the Department’s Medical Programs via the web-based system known asIllinois Medicaid Program Advanced Cloud Technology (IMPACT). Under the IMPACTsystem, category of service (COS) is replaced with Specialties and Subspecialties. Whenenrolling in IMPACT, a Provider Type Specialty must be selected. A Provider TypeSubspecialty may or may not be required.Consistent with 89 Ill. Admin. Code 140.452, MRO-MH and TCM services may be deliveredby enrolled Community Mental Health Centers (CMHCs), Behavioral Health Clinics (BHCs),or Independent Practitioners (IPs). Entities seeking enrollment as a provider of MRO-MHand TCM services may not seek reimbursement from any public payer until the entity’sIMPACT application, including any necessary certifications or Program Approvals, has beenapproved. Please see Sections 207 and 208 of this handbook for additional information onservice delivery requirements, including providers who are qualified to receivereimbursement.202.1IP EnrollmentIndependent Practitioners (IPs), as defined in 89 Ill. Admin. Code 140.452(a)(3), mayreceive reimbursement for the delivery of a limited number of MRO-MH services (refer toSection 208.3, Group A services). IPs seeking to provide MRO-MH services must enrollunder the appropriate Provider Type for their licensure, consistent with the policies andguidance outlined in the Handbook for Practitioners Rendering Medical Services. Refer toIMPACT Provider Types, Specialties and Subspecialties for additional information.202.2CMHC EnrollmentEntities enrolled and certified, pursuant to 59 Ill. Admin. Code 132, as a CMHC may receivereimbursement for the MRO-MH and TCM services described in Section 208. In order toenroll with HFS, CMHC (legacy Provider Type 036) providers must complete and submit aFacility, Agency, Organization (FAO) enrollment application through the IMPACT system,selecting all necessary Specialty/Subspecialty combinations based upon the services theprovider intends to provide.All CMHCs must minimally select a Specialty of ‘Outpatient’ or ‘Residential Services’ on theirenrollment application. CMHCs selecting with the Specialty of ‘Outpatient’ shall deliverMRO-MH and TCM services on a non-institutional basis to participants in the office, home,or other community settings and shall ensure their facility is open and willing to acceptreferrals for MRO-MH and TCM services for participants enrolled in one of the HFS fullbenefit Medical Assistance Programs. CMHCs should select the Specialty of ‘ResidentialServices’ to indicate that participants receive room and board as a component of theirtreatment at the provider’s primary practice location, as indicated on the provider’s IMPACTapplication.

Provider Specific PoliciesCommunity-Based BehavioralServices Provider HandbookTable 1. IMPACT Enrollment Guide – CMHCsProviderEnrollmentSpecialty nization(FAO)Community MentalHealth mmunitySupportTeamMobile CrisisResponseCrisisStabilizationPage 7Date:October 1, 2018Services IATPCrisis InterventionTherapy/CounselingCommunity SupportMed. Admin.Med. MonitoringMed. TrainingCase ManagementDevelop. ScreeningDevelop. TestingMH Risk AssessmentPrenatal Care At-RiskAssess.Telepsych: Orig. SiteIATPCrisis InterventionTherapy/CounselingCommunity SupportMed. Admin.Med. MonitoringMed. TrainingCase ManagementDevelop. ScreeningDevelop. TestingMH Risk AssessmentPrenatal Care At-RiskAssess.Telepsych: Orig. SiteIntensive OutpatientProgramApprovalClaimTypeN/AN/AIOP PsychosocialRehabilitation Assertive CommunityTreatmentPSR Community SupportTeamCST Mobile CrisisResponse Crisis StabilizationMCRACTSTA837P