These are six options for determining a payable amount for a consumer of DHS-funded community mental health services when the consumer is not enrolled in a DHFS health care program (such as Medicaid, Kid Care, All Kids) and there are other payers for the service. DHS funding may be used to pay for community mental health services for persons enrolled in a DHFS health care program, but the policies and procedures for determining the payable amount in those cases are already established. In all options presented here, it is understood that DHS payment for community mental health services will not exceed the DHS rate or the provider's usual and customary charge, whichever is the lower.
For these options, third party payments are generally payments from insurance or other benefit programs, including Medicare, that have an obligation to pay for services provided to a beneficiary. In instances in which a consumer is a beneficiary of more than one program with a third party payer, these options assume that third party payments represent the sum of all payments from these other parties. Consumer payment in these discussions means any payment made by the consumer or the consumer's family. In all cases, payment means the actual receipt of payment, not just a charge. If a consumer is charged a fee of $5 for a service but does not make any payment, the consumer payment is zero.
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
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