From:  Maria Bruni, Acting Director
Division of Alcoholism and Substance Abuse

SUBSTANCE USE DISORDER TREATMENT AT NURSING HOME LOCATIONS

In December of 2014, a moratorium was placed on renewing or granting any additional exceptions for the delivery of off-site substance use disorder services at nursing homes. While services have been provided in this setting for approximately eight years, increases in the number of exception requests and the number of billed service hours raised concern regarding medical necessity and the treatment modalities utilized for this population.

During this moratorium, DASA staff were directed to conduct a review of off-site services delivered at nursing homes to examine patient demographics, level of intensity and medical necessity of these services. At the conclusion of these reviews, it became clear that off-site services delivered to a patient in a nursing home were primarily a subset of a larger problem relative to how off-site services were being delivered in general.

To address the larger problem, new guidelines were issued regarding licensure exceptions for off-site services and these were communicated in a Smart Alert issued in September of 2015. As of March 1, 2016, these same guidelines will also apply to off-site exceptions granted at nursing homes. As is current practice, patient records at all off-site locations may be subject to on-site review for medical necessity and continued stay.

Licensed providers can now submit application for this type of off-site service.

Thank you in advance for your cooperation, patience and assistance. As always, please contact DASA Help at DHS.DASAHELP@ILLINOIS.GOV with questions.