A reimbursable service is that for which payment has been or can be made by the Department. Covered services are specified in this section and are those that are generally recognized as reasonable and necessary for the diagnosis, care, treatment or rehabilitation of alcoholism and substance abuse as defined in 77 Ill. Adm. Codes 2060. Contract dollars can be used for covered services for all eligible patients, including those who have exhausted other third-party coverage (Medicare, Medicaid, insurance, etc.), provided that such services are authorized in the provider's contract, there is money available in the contract to be earned, and there is documented clinical justification to deliver services in accordance with the specifications contained in Part 2060.

Covered Services and Established Guidelines

Covered Service Established Guideline (per state fiscal year)
Admission and Discharge Assessment One per episode of care
Level I Clinically justified need
Level II Clinically justified need
Level III.1 (Extended Residential Care) Clinically justified need
Level III.7D (Medically Monitored Detoxification) Clinically justified need
Level III.2D (Clinically Managed Detoxification) Clinically justified need
Level III.5 (Day Treatment) Clinically justified need
Level III.5 (Room and Board Only) Clinically justified need
Level III.5 (Residential Rehabilitation) Clinically justified need
Psychiatric/Diagnostic Payable per encounter (one per day)
Case Management, Early Intervention, Community Intervention Combination of Case Management, Early Intervention and Community Intervention maximum allowable referenced in DASA Exhibit 1.
Recovery Home - Adult Clinically justified need
Recovery Home - Adolescent Clinically justified need
Opioid Maintenance Therapy Clinically justified need
Toxicology Clinically justified need
Child Domiciliary Support Clinically justified need
HIV Counseling and Testing Clinically justified need