Effective January 1, 2006, three Rule 132 services provide a rate for the direct involvement of more that one staff person. The following information defines the requirements for billing the involvement of more than one direct care staff person.

Definition

Higher billing rate when multiple provider staff are intervening simultaneously with or on behalf of the client.

Scope

  1. Effective for dates of service beginning with January 1, 2006.
  2. Covers the following three services when billed fee-for-service
    • Crisis Intervention
    • Crisis Intervention-Pre-Hospitalization Screening (SASS-only)
    • Intensive Family Based Services (Only for SASS clients or by contractual arrangement with DCFS)

Service Requirements

  1. More than one provider staff person is needed to directly intervene to address the client's situation.
  2. Staff must be from the same provider organization. Staff may be from the same program or from different programs within the provider's organization.
  3. The staff covered by the multiple staff billing episode must meet Rule 132 requirements for staff qualifications.
    • Example: If two staff are providing Intensive Family Based Services, both must be at least MHP level.
  4. The service is delivered off-site at a location that is not a hospital setting.

Documentation Requirements

  1. Service note must identify the multiple staff involved, by name.
    • Each staff person intervening during the multiple staff billing episode does not need to write his/her own note for the episode, as long as the consolidated note names the other staff involved and covers the other required elements for documenting the episode. Multiple notes for the episode are also acceptable.
  2. Service note must describe what each staff person did during the multiple staff billing episode.
  3. The note must support the need for multiple staff intervening to address the client's situation.

Billing Requirements

  1. The time associated with the delivery of the service is the time that should be billed, except for crisis intervention - pre-hospitalization screening (see # 3).
    • Example: Two staff intervene for one hour, delivering crisis intervention services (billed in 15 minute units) off-site/non-hospital setting. One bill is submitted at the multiple staff rate for 4 units of crisis intervention services.
  2. Multiple staff billing is allowed only for the amount of time when multiple staff were involved.
    • Example: Two staff intervene for 45 minutes of crisis intervention services off-site/non-hospital setting. One staff leaves; another staff stays and continues to deliver crisis intervention services for an additional 30 minutes. The 45-minute time block (3 units) can be billed at the multiple staff billing rate. The additional 30 minutes (2 units) must be billed at the standard off-site rate.
  3. Crisis Intervention-Pre-Hospitalization Screening is billed on an event mode basis and thus cannot be split into eligible and ineligible portions of the episode. As long as part of the Pre-hospitalization screening episode met all of the requirements for multiple staff billing, the episode can billed at the multiple staff billing rate for that service.
  4. Submitting Medicaid billing at the multiple staff rate depends on how the billing is submitted.
    • If billing HFS directly, include the HT modifier along with any other modifiers required for the service.
    • If billing DHS through ROCS, use the DHS service activity codes identified in the Revised Service Activity Crosswalk.
    • If billing DCFS through MBS, select the service line that is identified as being for multiple staff.

Resources

  1. Service Activity Crosswalk, revised 1/1/2006: www.dhs.state.il.us/revisedRule132
  2. Rule 132 Services Rate Table, effective 1/1/2006: www.hfs.illinois.gov/assets/022406rate.pdf
  3. Rule 132 E-mail: Rule132@idcfs.state.il.us
  4. DHS-DMH E-mail: dhs.mh@illinois.gov
  5. ROCS E-mail: rocs@dhs.state.il.us