- I. Introduction/Definition
- II. Policies & Procedures
- III. Contract and Amendment Process
- IV. Deliverables/Costs/Rates/Payments
- V. Provider Responsibilities
- VI. Department Responsibilities
- VII. Support Services
- VIII. Billing Instructions
- IX. Program Monitoring
- X. Appendix - State Authoritative Sources
The Department of Human Services/Division of Mental Health (DHS/DMH) Program Manual is a resource for funded providers to obtain more detail about procedures or requirements contained in the Attachment B to the Community Services Agreement and the DHS/DMH Provider Manual.
II. Policies & Procedures
DHS/DMH has the following detailed policies and procedures in certain program areas:
- It is the policy of DHS/DMH that Medicaid eligible individuals in the target or first presentation of psychosis populations must be given priority for services. Similarly, within the DHS/DMH funding available to the provider, individuals who are not Medicaid eligible and in the target or first presentation of psychosis populations must be given priority for services.
- Individual Care Grants
- The parent(s) involvement includes family therapy, treatment plan development and reviews, periodic staffing, participation in ongoing treatment, transition planning, medication changes, parent support activities and discharge planning.
- The residential Provider shall be paid for services at a specified per diem rate and is also required to submit encounters for residential treatment services at the DHS/DMH specified target in accordance with DHS/DMH requirement. The community Provider that provides ICG services will be reimbursed at the rates specified for the services billed. Residential per diems and certain community services require authorization prior to payment. Payment will not be approved without written authorization from the parent(s) indicating involvement with the treatment planning process.
- The Provider agrees that neither the individual nor her/his family will be assessed a fee or any other type of financial obligation that supplements the rate established by DHS.
- Residential and community providers that provide ICG services will utilize the information and billing system prescribed by DHS/DMH to receive payment for approved services.
- The Provider shall report admission of ICG clients no later than 72 hours after the admission date according to authorization requirements. If an admission is not reported in writing to the ICG program office within this period, the Provider will not be reimbursed for any days prior to receipt of the notification.
- Residential and community ICG providers must inform the parent(s)/guardian(s) about the requirement to apply for SSI and/or Medicaid, and assist them if necessary. Social Security benefits must be applied to the cost of residential care to the extent provided by the law.
- The Provider must document the treatment plan and progress toward achievement of the youth's goals and objectives in the quarterly and annual report. The plan should also address the following components of the transition plan: employment, higher education and career-track planning, living situation, community life adjustment and ongoing mental health care.
- Residential and SASS providers, in concert with the youth, the youth's local school district, adult network, and ICG office must work collaboratively on a transition. Transition planning should begin at age 16, one year prior to the youth's 17th birthday.
- Youth leaving residential placement shall not be discharged without adequate services being in place in the community at the time of discharge. Discharge plans must be completed prior to the child's discharge and must be coordinated with the youth, the parent(s), the local school district and the community mental health provider. Discharge planning should include review of the ICG Discharge Planning Checklist to insure a comprehensive plan.
- The Provider shall provide the following reports within the given time frame:
- Quarterly reports (Residential and community providers)
- Six month reports (Community providers only)
- ICG annual review document
- Incident Reports on significant and sentinel events must be reported to the ICG office within 24 hours of the incident. A sentinel event should be reported immediately to the licensing agent and then reported to the ICG office (773/794-4847) (Residential only).
- Medicaid Enrollment
- All community mental health providers with contracts to provide services defined in 59 IL. Admin. 132 must be certified and enrolled as Medicaid providers for each of their DHS/DMH funded sites. The Division will act as a liaison between the Department of Healthcare and Family Services (DHFS) and community mental health providers to assist providers who qualify to enroll as Medicaid providers.
- Preadmission Screen/Mental Health (PAS/MH) Contractor's Procedure Manual available at:
- Forensic Training Manual for Fitness Restoration of Individuals found Unfit to Stand Trial (UST):
- DMH Community Mental Health Provider Manual is available at:
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III. Contract and Amendment Process
- The DHS Community Services Agreement between the Department and the Provider is generally referred to as the Agreement and consists of several parts:
- DHS Community Services Agreement containing the standard contract language for all Department agreements.
- Contract Attachment B containing specific agreement requirements related to programs funded by the DMH.
- Community Services Agreement Exhibits A - C showing the contract information, the method of payment, the method of reconciliation, and any contract deliverables.
- The Department will initiate the Agreement, send it to the Provider for review and signature, obtain the Secretary's signature and return a copy of the executed agreement to the Provider. The Agreement is not effective until signed by the Secretary of DHS.
- Amendment Procedures
- The Department will initiate a two-party signed amendment to the contract when changes are made to the contract that are beyond the scope shown in Attachment B.
- DMH contract deliverables are specified in DMH Attachment B and the Community Services Agreement Exhibits A - C for each provider. DMH Attachment B & Program Manual may be obtained at the following internet address listed under (Mental Health): (http://intranet.dhs/oneweb/page.aspx?item=65378)
- Payment and Rates
- The maximum payment during a fiscal year to Providers under a contract with DHS/DMH is the total contract amount displayed on the Community Services Agreement Exhibits A - C. Payment for Medicaid services to Medicaid eligible individuals is not part of the total contract amount.
- Individual Care Grant (ICG) rates are established for in-state providers by the Illinois Purchase Care Review Board. Agreements with our Department and the Department of Children and Family Services (DCFS) have established that any rate set by DCFS will be accepted by DMH for services to our recipients served in the same provider site. There are situations when DCFS and DMH have agreed to share costs on some basis, typically half-and-half. There are also other instances of special service needs where the DMH ICG Program Director will negotiate a rate with a particular provider.
- For out-of-state ICG providers their respective in-state Purchase of Care Review Boards may set the rates.
- Provisions for payment are described in Section IV of the DMH Attachment B.
- Pre-Admission Screening for Mental Health (PAS/MH)
- Contracted PAS/MH agencies will perform Pre-Admission Screening and Resident Review as assigned by DHS/DMH. Contracted PAS/MH agencies responding to the 2007 PAS/MH RFP will perform Pre-Admission Screening, Resident Review and Targeted Case Management as asssigned by DHS/DMH.
- Service requirements, rates, payment limits and conditions are described in the PASRR manual available at: (PAS/MH) Contractor's Procedure Manual (pdf)
- PASRR contractors will report and bill Pre-Admission Screening and Resident Review using the information and billing system prescribed by DHS/DMH to receive payment for approved services.
- Targeted Case Management services may only be provided with prior authorization from DMH Central Office. These services will be provided in accordance with Administrative Rule 132. With prior approval services will be billed directly to the Illinois Department of Healthcare and Family Services through the web-based PASRR reporting system.
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V. Provider Responsibilities
Funded providers are expected to be in full compliance with all laws, rules, policies, procedures and mandates specified in the Community Services Agreement, DHS/DMH Attachment B, as well as other applicable administrative rules and all other referenced documents. It is the responsibility of the Provider to notify their DHS/DMH Region Office of any difficulties in meeting any contractual obligation.
VI. Department Responsibilities
DMH is responsible for activities including, but not limited to:
- Executing the Community Services Agreement according to the provisions contained therein including the DMH Attachment B and applicable federal, state and local laws and rules as enumerated in that Attachment;
- On-going monitoring of Provider services and funding;
- Notifying Providers of changes or additions made to documents referenced in this manual.
VII. Support Services
Providers may request technical assistance by contacting their DHS/DMH Regional office.
VIII. Billing Instructions
Billing instructions for mental health Medicaid, PAS/MH (Pre-admission Screening/Mental Health), and ICG (Individual Care Grants) can be obtained by contacting the DHS/DMH Regional Office.
IX. Program Monitoring
- The Provider shall allow the Department or its agent access to its facilities, records and employees for the purposes of monitoring this Agreement. The Department will monitor compliance with the conditions specified herein. Monitoring will be conducted by staff within various offices of the Department, including but not limited to the:
- Division of Mental Health
- Bureau of Accreditation, Licensure, and Certification
- Office of Contract Administration,
- Office of the Inspector General
- The Illinois Mental Health Collaborative for Access and Choice
- The Department or its agent will share any findings arising from its monitoring activities of the Provider for review and corrective action to the Provider. The Provider shall submit corrective action plans to DHS as requested, and shall comply with plans of correction approved or imposed by the Department. Monitoring may consist of, but is not limited to, the following:
- Reviews of all required licenses and certifications;
- Reviews of all provider service and funding plans;
- Reviews of direct service provision;
- Reviews of substantiated cases of abuse and neglect;
- On-site reviews of client records, personnel files, agency and program policies and procedures, and financial records;
- On-site observations and interviews of clients, guardians, and agency staff (including, but not limited to, program supervisory and direct care staff);
- Reviews of electronic data submissions and verification of data submissions or data accepted in lieu of electronic submission;
- Reviews of utilization patterns; and
- Reviews of training records.
X. Appendix - State Authoritative Sources
As the Provider, in addition to State and Federal rules and regulations governing the programs you deliver you are responsible for complying with all of the State sources below, if applicable:
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