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

CLARIFICATION TO MEDICAID BILLING AND DASA CONTRACT FUNDS POLICY, EFFECTIVE SEPTEMBER 1, 2016

DASA Smart Alert (Volume X, Issue III) described an amended policy, effective September 1, 2016, regarding the use of fixed-rate grant funds contained in a DASA contract to pay for Medicaid covered services to eligible patients and Medicaid certification and site enrollment for organizations with DASA contracts. Since that time, we have received a number of inquiries requesting clarification to this policy. This Smart Alert contains the DASA response to those questions/concerns.

  1. The new policy applies to services delivered on or after September 1, 2016.
  2. All organizations with DASA contracts must obtain Medicaid certification and enrollment for all licensed sites for applicable services. If this requirement applies to your organization, the certification or enrollment process should be started immediately.
  3. DASA contract funds cannot be used for Medicaid eligible services to a patient covered by a Medicaid Managed Care Organization (MCO).
  4. All DASA treatment services that are contract, Medicaid fee-for-service (FFS) or MCO reimbursed must have medical necessity determined at the point of diagnosis. In the case of court ordered treatment, the current procedure outlined in Administrative Rule, Part 2060, Section .403 must be followed.
  5. DASA recognizes that there will be a few exceptions to this policy relative to those patients with Medicaid fee-for-service coverage. One of these exceptions is related to patients in an Institute for Mental Disease (IMD) residential facility. Providers can continue to bill DASA contract funds for Medicaid patients admitted to these facilities ONLY if they have FFS non-MCO coverage. Another identified exception is for the day of discharge for a youth in a PRTF (Psychiatric Residential Treatment Facility). Please contact DASA with any other exceptions you may have identified and, if approved, they will be exempt from any edits and post-payment audit.
  6. DASA expects that providers will exercise due diligence in determining the correct fund to bill for reimbursement to ensure that increasingly limited contract funds are available for those with no other resources. Additionally, please ensure that documentation is present in the patient record to justify billing for any service or fund source as they will be subject to selective post-payment audit and possible recoupment.

Please contact DHS.DASAHelp@Illinois.gov with any questions you may have regarding this communication.