From: Theodora Binion, Director
Division of Alcoholism and Substance Abuse

PATIENT INCOME ELIGIBILITY POLICIES AND IMPLEMENTATION

The Illinois Department of Human Services recently conducted an audit of DASA providers to look at the extent to which providers complied with DASA's patient income eligibility policies and implementation. The audit focused on the following: 1) assessment of patient co-payment and the development of a sliding fee schedule, 2) use of the income eligibility override criteria, and 3) proper documentation of patient income for the determination of eligibility.

The auditors found that providers were not consistently complying with the standards outlined in the administrative rules and that DASA must assure appropriate corrective action when needed. Consequently, beginning July 1, 2013, the review of these policies and procedures will become a part of DASA's post-payment audit and contract monitoring and compliance review processes as follows.

1) Assessment of patient co-payment and the development of a sliding fee schedule:

  • Title 77 Illinois Administrative Code, Section 2030.450, Title 89 Illinois Administrative Code, Section 509.30 d), and the DASA Contractual Policy Manual (page 4): Any patient utilizing DASA funding for treatment or intervention services shall be assessed a co-payment. This includes Medicaid eligible patients receiving non-Medicaid eligible services.

2) Use of the income eligibility override criteria:

  • Please find this policy in the DASA Contractual Policy Manual (page 3). Only those patients who do not meet DASA's financial requirements, but are assessed with financial hardship using one of the criteria listed can utilize the income eligibility override. Beginning in July of 2013, a post-payment audit finding in this area will result in recoupment.

3) Proper documentation of patient income for the determination of eligibility:

  • Please find policies regarding this in the DASA Contractual Policy Manual (pages 2-4). Proof of income and proper documentation, including staff attempts to obtain this information, must be maintained in the patient clinical or financial chart. Beginning in July of 2013, a post-payment audit finding which shows this documentation absent in this area will result in recoupment.

Please send any questions or comments you may have to the DASA Help Desk at DHS.DASAHELP@ILLINOIS.GOV or you may contact your contract manager for further clarification.