From September 25, 2018

Question: Under the new Integrated Health Homes (IHH), we have been told by DHS/DMH that we will not be able to bill case management for clients who are enrolled in an Integrated Health Home, regardless of who the IHH provider is. Will a patient's status in an integrated health home affect our ability to bill case management through SUPR?

Answer: No, it will not. The prohibition by DHS/DMH only pertains to Targeted Case Management billed to Medicaid by Community Mental Health Centers for persons with mental health disorders. However, you must ensure that there is no duplication of case management service billing between SUPR and DMH .

Question: What is the process to get additional locations added as SUPR designated providers? We want to add several of our FQHC sites, so we can expand our MAT services, we will get a new NPI for each new SUPR site.

Answer: Submit a complete application for intervention/treatment license and/or Medicaid certification for each location you wish to add. The license fee is per-site and must be in separate checks. Application requirements and forms can be located at: http://www.dhs.state.il.us/page.aspx?item=68564

Regarding the NPI number, FQHCs only need one NPI number for all services at all their sites. Any need for additional clarification should be directed to Jayne.Antonacci@illinois.gov.

Question: Regarding medical services provided at a SUPR location, is there a COS we need to add to get these paid? If so, what is it? We are not getting paid by the MCO's for these services. Example: at our Women's Residential Services site, we have one of our FQHC medical providers come on-site to perform a variety of medical services i.e. if client is sick and needs exam/meds, STI testing and treatment, Hep testing. MCO's are not paying for the above professional fee's

Answer: Medical services are not a DHS SUPR billable service. You must seek other funding for medical services, send to an FQHC, or utilize other medical resources.

Question: What is considered the "Admission Date"? According to 2060.417, an assessment shall be conducted prior to admission to any level of care. The assessment of the severity of the six dimensions established in the ASAM Patient Placement Criteria determine what level of care they will be admitted to. We can't always get that completed on the first appointment date. I would interpret that as the date the client is admitted to care would be the date the assessment is completed with the recommended level of care and diagnosis if applicable.

Answer: The admission date is the date of the first treatment service (individual or group counseling). The Assessment is not treatment.

Question: Can we document in a treatment file if a client reports their reason for being here as "I got a DUI and have to do hours"? We make it very clear to our clients that treatment is not focused on hours or their DUI charge and that treatment is focused on them meeting treatment goals. I still think it is relevant to report the client's stated reason for coming to treatment.

Answer: It is relevant to document the reason for a referral which in this case would be the DUI. However, a treatment plan is based on the patient assessment and medical necessity for treatment. The DUI is a consequence of the substance use disorder. Simply stating that the problem area in a treatment plan is the DUI and required treatment hours does not support medical necessity.

Question: If a client has an assessment but doesn't follow through with services and is closed, then returns for services, can the previous assessment and intake paperwork be used? Can we review the information to be sure it is still accurate and sign and date with current return date or do we need to start over with all the paperwork and assessment?

Answer: You must follow your medical director and/or agencies' board approved written policy for reassessments (return to treatment policy), follow ASAM and use clinical judgement to readmit the patient.

Question: Are there any implications with DARTS if they close the file?

Answer: Any patients receiving level 3 services must be closed in DARTS after 3 days of no contact. Any level .5 client or levels 1 or 2 patients must be closed in DARTS after 30 days of no contact. This may not be the same timeline as the need for reassessment, but a new opening will need to be submitted through DARTS if the patient returns after any of these absences.

Question: We are still having problems receiving RIN numbers in a timely manner causing claims to be delayed in submission and in many times denied for timely filing. How can we obtain numbers more quickly?

Answer: We have reached out to DHS/DFCS and we are waiting for a response regarding the delay in e-rin numbers.

Question: We also see many undocumented clients and the e-rin staff are asking for SSN numbers which just do not exist, how do we move forward, especially when they are common names like Juan Rodriguez (fake client, common names)

Answer: For individuals who do not have an assigned SSN you will use all zeros.

Question: Does documentation such as releases of information and consent to treatment need to have a CADC signing as witness?

Answer: No. However, for any legal document such as the patients' rights, or consent to treatment, the witness must understand and must be able to explain the content and intent of each form.