Support Billing Procedures
The IDHS/SUPR billing procedures have been revised to reflect the elimination of contract allowances for supportive services and the addition of billable activities including recovery support services (RSS). This revision also includes clarification on income eligibility guidelines, the current payor of last resort policy and information about IDHS/SUPR Billing Verification Report.
Early Intervention (EI):
In addition to the current identified billable activities for Early Intervention, this is a reminder that early intervention services for DUI offenders who have been evaluated as moderate risk can also be billed for the required 10 hours of early intervention. This service would be billed by the licensed treatment organization and reimbursed at the standard EI individual or group rate.
Community Intervention (CI):
Staff time spent in a SUPR sponsored training can be billed to Community Intervention using activity code 35. This allowance does not include travel time to and from training. For example, if a SUPR-sponsored ASAM training is from 9:00-4:00, a total of 7 hours of CI could be billed.
Recovery Support Services (RSS):
Recovery Support Services include employment, peer and recovery coaching, recovery homes, recovery skills, spiritual support, transportation and employment training. If RSS are provided, they must be delivered and billed to the IDHS/SUPR contract as follows:
- A Certified Peer Recovery Support Specialist (CPRS) or a Certified Recovery Support Specialist (CRSS) must deliver the service. If the organization is unable to meet this requirement, an exception request must be submitted to IDHS/SUPR. If an exception is granted, at a minimum, the staff providing RSS must be a person with lived experience and one year of recovery.
- RSS is a separate service from substance use disorder (SUD) treatment and should not be delivered by the same staff to the same patient. Ideally, professional staff are delineated such that they are not providing both treatment and recovery support services at the same organization.
- RSS must be identified and documented as a need in the ASAM assessment or any continued stay review.
- RSS must be documented in a recovery support plan that is separate from the treatment plan and must address the four major dimensions of recovery identified by the Substance Abuse and Mental Health Service Administration.
- RSS services must be signed by the staff delivering the service and indicate the activity, time date and duration.
- RSS delivered during treatment (except recovery home and transportation) is reported as case management (CM), activity code 21 and reimbursed at the CM rate. RSS delivered pre-treatment or post treatment is reported as community intervention (CI), activity code 32 and reimbursed at the CI rate. Reference the billing chart below for rates and documentation requirements.
- Recovery Home services will continue to be reimbursed at the standard recovery home rate and transportation will continue to be billed as community intervention. Please refer to the Contract Policy Manual for details.
Income Eligibility:
DARTS has always allowed for an override for patients who would not otherwise meet the income eligibility requirements to access SUPR contract funds, but for whom payment is a barrier to accessing treatment. Please consider using this override for any patient with no other third-party reimbursement and/or income too high to qualify for SUPR funding but who can still demonstrate financial hardship. As always, SUPR funds can be used to cover deductibles, co-payments and Medicaid spend down amounts.
Payor of Last Resort and IDHS/SUPR Billing Verification Report:
To maximize all funding sources, the Substance Use Prevention and Recovery (SUPR) Contractual Policy Manual specifies the requirement for contract funded providers to establish policy regarding eligibility, billing and collection for services delivered and reimbursed through a SUPR contract.
In part, this policy requires each organization to have established policy regarding eligibility, billing and collection which ensures that third-party payment benefits, including Medicaid or other state or federal funds, are identified and accessed first before billing contract funding. To ensure this practice is followed, SUPR conduct verification of services billed to contract funds. If the service is Medicaid eligible, the patient's recipient identification number (RIN) is checked for Medicaid eligibility on the date of the service through the Healthcare and Family Service (HFS) eligibility system. If the patient was Medicaid eligible during this time, the contract claim should be re-billed as a Medicaid claim.
Organizations that have services identified that were reimbursed through SUPR contract but appear to have been Medicaid eligible will be sent a spreadsheet with this information and should expect the first spreadsheet, including data back to January 1, 2020, to arrive by the end of March 2020. The organization should check to confirm patient Medicaid eligibility information through the HFS MEDI system. If the patient was eligible on the date of service, the service must be re-billed to the patient's Managed Care plan or to Medicaid fee-for-service, whichever is applicable. Please take into consideration the 180-day timely filing requirement for Medicaid billing.
The IDHS/SUPR Billing Verification Report will continue to be sent monthly. More information about this policy will be forthcoming.
Contact the SUPR Help Desk with any questions on these revisions at DoIT.SUPRHelp@illinois.gov .
