Division of Behavioral Health and Recovery Substance Use and Gambling Disorder Services Contractual Policy Manual FY 2026

• Table of Contents

1. Introduction
2. General Requirements
3. Eligibility - Organization and Patient
4. Reimbursement Policy
5. FY 2026 Reimbursement Rates
6. Reimbursement/Disbursement Specifications
7. Funding Specifications
8. Subawards
9. Billing Requirements
10. Payment Inquiry Information
11. Service Requirements

Introduction

The information contained within this manual is applicable to all Division of Behavioral Health and Recovery (IDHS/DBHR) substance use and gambling disorder  funded organizations with a grant agreement/contract to provide substance use and gambling disorder prevention, intervention, treatment and recovery support services as authorized by the Division of Substance Use Prevention and Recovery (SUPR). Each grant agreement/contract specifies funding deliverables.  The policy and procedures contained within this manual are based upon rules and/or grant agreement/contract conditions in effect for Fiscal Year 2026. Where applicable, the specific source of the mandate is referenced. The term "organizations" as referenced in this manual means licensed/Medicaid certified organizations with funding for intervention or treatment services, licensed and/or Medicaid certified organizations with funding for non-licensable services or organizations with funding for specified activities or services.

Full compliance with and a thorough understanding of Department and Division rules and procedures are expected of all funded organizations. Most reporting and billing errors that cause delay of payment and incorrect analysis of data can be prevented by correct utilization of reporting software and adherence to procedures established in this manual.

IDHS/DBHR has an established Help Desk e-mail and fax number for all organizations to utilize when there are questions regarding grant agreements/contracts and/or funding requirements. This e-mail address is DoIT.SUPRHelp@illinois.gov and the fax number is 217-558-4656.

Definitions

1. 77 Ill. Admin. Code 2060- refers to Administrative Rule: Title 77: Public Health Chapter X: Department of Human Services Subchapter d: Licensure Part 2060 Substance Use Disorder Treatment and Intervention Services.
2. Admission - means acceptance of a person into an intervention or treatment service, after completion of intake process, assessment for a diagnosis and placement into a level of care, the person has given written informed consent for treatment, and the person has been accepted for and begins such treatment.
3. Adolescent - A person who is at least 12 years of age and under 18 years of age. For purposes of admission to adolescent treatment, a person between the ages of 18 and 22 may be admitted if the assessment includes justification based upon the person's behavior, life experience, and developmental appropriateness.
4. Adult - A person who is 18 years of age or older. For purposes of admission to adult treatment, adolescents who are 16 and 17 may be admitted if the assessment includes justification based upon the adolescent's behavior, life experience, and developmental appropriateness.
5. The American Society of Addiction Medicine (ASAM) Criteria - Defined national standards for level of care placement, dimensional admission, treatment planning and assessment, continued services and transfer criteria for patients with substance use and co-occurring conditions that organize substance use treatment services into discrete and standardized levels of frequency and intensity across a continuum, as developed by the American Society of Addiction Medicine and documented in "The ASAM Criteria Third Edition: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions" (2013), available through the American Society of Addiction Medicine, 11400 Rockville Pike, Suite 200, Rockville, MD 20852. Effective July 1, 2025, the ASAM Criteria documented in "The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, Fourth Edition" (2023), available through the American Society of Addiction Medicine, 11400 Rockville Pike, Suite 200, Rockville, MD 20852 shall be used for adult services licensed under this Part.
6. Assessment - The process of collecting and professionally interpreting data, from a person, significant other, and other collateral sources, about substance use and its consequences as a basis for establishing or ruling out a diagnosis in accordance with the DSM-5. Assessment, utilizing the ASAM criteria, is also used to determine the severity of the disorder and identification of the appropriate level and intensity of substance use disorder treatment as well as needs for other services. Assessment is on-going throughout treatment and is also used to make continued service and discharge recommendations. Assessment is conducted by professional staff, as defined in Section 2060.320, of a IDHS/DBHR licensed treatment organization.
7. Authorized Organization Representative - A person designated by the organization as the authority for the management, control, and operation of all services relative to each license and/or grant. This person is the primary recipient of communication from the IDHS/DBHR relative to the issued license and is responsible for the dissemination of those communications across the organization.
8. Case Management - A coordinated approach to the delivery of health and medical treatment, substance use disorder treatment, mental health treatment, and social services, linking patients with appropriate services to address specific needs and achieve stated goals. In general, case management assists patients with other disorders and conditions that require multiple services over extended periods of time and who face difficulty in gaining access to those services.
9. Client - A person who receives DUI evaluation, DUI risk education, and designated program services as defined in Sections 2060.510 through 530, or who receives early intervention services as defined in Section 2060.405.
10. Clinical Treatment - substance use disorder treatment provided by professional staff, as defined in Section 2060.320, that includes assessment, individual or group counseling, treatment planning, continued service reviews, and recovery/discharge planning. The organization may also determine that other specified activities require the services of professional staff.
11. Continuing Care Plan - A plan developed with the patient prior to discharge that identifies recommended activities, referrals, and other recovery support that will reinforce and enhance progress, to date.
12. Continuum of Care - A structure of interlinked treatment services, either offered by one organization or through referral to other organizations, that is designed to meet changing needs as the patient transitions through treatment and recovery.
13. Department - The Illinois Department of Human Services (IDHS).
14. DARTS - Department Automated Reporting and Tracking System. Any mention in this document of DARTS also includes any reporting and billing system developed during the fiscal year that may replace DARTS functions,
15. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) - Publication from the American Psychiatric Association (APA) which codifies diagnose of mental disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM-5 (2022), is available through the American Psychiatric Association, 800 Maine Avenue, SW, Suite 900, Washington, DC 20024.
16. Discharge - When services are terminated either by successful completion or some other action initiated by the person or the organization.
17. Early Intervention - Services authorized by a treatment license. Early Intervention services are sub-clinical and pre-diagnostic and that include a written plan designed to further identify and address risk factors that may be related to problems associated with substance use or that may lead to a substance use disorder. Early intervention assists persons in recognizing harmful consequences, facilitates emotional and social stability, and includes referrals for higher levels of care, when necessary.
18. Facility - Means the building or premises that are used for the provision of licensable services, including support services, as set forth by rule.
19. Gambling Disorder or Problem gambling - The Diagnostic and Statistical Manual 5th edition defines gambling disorder as a persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress.
20. Illinois Certification Board, Inc. (ICB) - The organization that issues credentials to professionals seeking to provide IDHS/DBHR licensable substance use disorder intervention and treatment services. This organization is also known as the Illinois Alcoholism and Other Drug Abuse Professional Certification Association (IAODAPCA).
21. Individualized Treatment - Care that is person-centered and collaboratively designed to meet a particular patient's needs and preferences guided by services that are directly related to a specific, unique patient assessment.
22. Organization - Any public or private agency, person, association, corporation, or other unit of State or local government acting individually or as a group that applies for or obtains licensure to operate one or more substance use disorder intervention or treatment services.
23. Patient- means a person who receives a substance use disorder treatment service as defined in this Part from an organization licensed under this Part.
24. Recovery - means a process of change through which individuals improve their health and wellness, live a self-directed life, and reach their full potential. [20 ILCS 301/1-10]
25. Recovery Support - means services designed to support individual recovery from a substance use disorder that may be delivered pre-treatment, during treatment, or post treatment. These services may be delivered in a wide variety of settings for the purpose of supporting the individual in meeting his or her recovery support goals. [20 ILCS 301/1-10]
26. Residential Treatment- Is an organized treatment services that include a planned and structured regimen of care in a 24-hour residential setting. Residential services exist on a continuum ranging from least intensive to the most intensive medically monitored service. The ASAM levels of care licensed by IDHS/DBHR as residential treatment are Levels 3.1, 3.5, and 3.7.
27. Substance Abuse and Mental Health Services Administration (SAMHSA) - Federal agency responsible for guidance to the State Substance Use and Mental Health Authorities, including administration of the federal block grants, defining, and identifying evidence-based practices, and translation of research to practice.
28. Substance Use Disorder (SUD) - means a spectrum of persistent and recurring problematic behavior that encompasses 10 separate classes of drugs: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, and tobacco, and other unknown substances leading to clinically-significant impairment or distress. [20 ILCS 301/1-10]
29. Transfer is the process that occurs when a patient cannot, or is no longer eligible, to receive services at an organization or the movement of the patient from one level of care to another within the same organization.
30. Treatment means the broad range of emergency, outpatient, and residential care (including assessment, diagnosis, case management, treatment, and recovery support planning) may be extended to individuals with substance use disorders or to the families of those persons.

General Requirements

Unless otherwise indicated, all funded organizations must comply with the following requirements:

Financial Management

All organizations shall have a written procedure for financial management that meets the standards for fund control as specified in U.S.C 2 CFR 200.302 (Financial Management). The written procedure must also identify the requirements that must be in effect to qualify and request an advance payment of grant agreement/contract funds as allowed in 2 CFR 200.305. The organization's grant manager or project director will be contacted if additional information is needed to meet this requirement.

Annual Online Certification Plan Survey

Organizations that receive Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG) for fixed-rate grant agreements for recovery home or substance use disorder (SUD) treatment services are required to complete the FY 2026 Annual Certification Plan (ACP) Survey.

Organizations that administer expense-based grants (e.g., prevention, gambling outreach, RCOs, ROSCs) are not required but encouraged to complete the Survey.

The ACP Survey provides IDHS/DBHR with critical data not reported through other systems. The data is needed for federal reporting purposes to help secure SUPTRS BG funding. IDHS/DBH uses this information and other data to track and report priority areas critical to the prevention, treatment, and recovery system. This plan also certifies receipt and understanding of all federal and state regulations applied to the grant agreement/contract award and any other terms and conditions in the FY 2026 grant agreement/contract and exhibits, IDHS/DBHR Attachment C and all applicable service requirements. All certifications are subject to on-site verification by SUPR staff. Substance Use Prevention only organizations are exempt from the annual CPS.

Relocation or Closure of Any Funded Service

The division shall be notified at least 30 calendar days prior to the relocation of any licensed substance use intervention or treatment facility. Organizations that relocate without proper notification to the Division may be required to pay an additional licensure fee or denied licensure.

Organizations must receive approval in writing from IDHS/DBHR at least 90 calendar days prior to the relocation or closure of any funded service. IDHS/DBHR may exercise its right to disapprove any movement of funded services or locations and may request the return of payments related service closures or relocations not approved by the Division.

Questions about relocating a license or funded services can be emailed to DoIT.SUPRHelp@illinois.gov. Organization should also email their grant manager prior to relocating services.

Overdose Prevention, Patient and Staff Training

Organization will ensure that professional and support staff shall receive opioid overdose education and training that includes how to recognize an overdose and instruction on how to administer naloxone, a life-saving medication used to reverse a suspected opioid drug overdose. Organizations must also ensure that naloxone is readily accessible to all staff members at each treatment facility and that such training is a part of any new employee orientation. Compliance with this section of the contract policy manual must be confirmed in the ACP for organizations that receive Substance Use Prevention, Treatment, and Recovery Services Block Grants. Additional information and training resources can be accessed at IDHS: IDHS/SUPR Drug Overdose Prevention Program (state.il.us) .

Organizations that provide Overdose Education and Naloxone Distribution (OEND) services can be located at IDHS: Illinois Overdose Prevention Programs: Contact Information (state.il.us).  Organizations are also encouraged to voluntarily enroll as a Drug Overdose Prevention Program (DOPP) provider if they provide naloxone to their patients or as an OEND site if they receive naloxone from one of the designated OEND organizations. Registration as an OEND organization through DOPP allows an organization to increase access to training and information for local residents, municipalities, and friends and families of those with an opioid use disorder (OUD). Voluntary enrollment information is available at IDHS: IDHS/SUPR Drug Overdose Prevention Program (state.il.us).

Public Act 99-0553 requires that all SUPR licensed substance use disorder (SUD) treatment organizations shall provide educational information to patients identified as having or seeking treatment for an opioid use disorder (OUD). The education should include the use of medication for an OUD, recognition of and response to an opioid overdose, and use and administration of naloxone. This must be a documented objective in such patient's treatment and continuing recovery plan.

Grant Agreement/Contract Adjustment

All organizations that receive notification to submit a revision to the Uniform Grant Budget (UGB) must complete this revision and submit their revised budget for approval within 45 calendar days of notification. If the revision is not received by IDHS/DBHR within this time frame, the Division reserves the right to void the adjustment.

Authorized Organization Representative

The organization shall designate one individual as the authority for the management, control and use of funding contained in the IDHS/DBHR grant agreement/contract(s). This individual shall be the same person for every grant agreement/contract and shall be the point of contact for all communication relative to those grant agreement/contract in addition to program staff assigned for programmatic issues. The Authorized Organization Representative is also responsible for sharing and communicating information sent from IDHS/DBHR with all applicable staff on a timely basis in order to ensure they have access to IDHS/DBHR policy changes, training opportunities and other news alerts. The organization shall notify the IDHS/DBHR, in writing, within ten calendar days, when there is a change in the Authorized Organization Representative. Changes in the Authorized Organization Representative will require an update of the Provider Profile in the CSA.

Charitable Choice

Any organization that identifies as religious or charitable must have current registration within the Illinois Attorney General Charitable Trust Database. To register, the organization must have written policies and procedures related to federal choice requirements specified in 42CFR Part 54. Information and the form required for registration can be obtained at:

Illinois Attorney General Charities

Capacity Management (CapMan)

Organizations licensed by IDHS/DBHR to provide the American Society of Addiction Medicine (ASAM) level 3.5 and Opioid Treatment Program (OTP) services are expected to report data in the Capacity Management (CapMan) system daily and per site. The CapMan system is accessed through the Illinois Helpline, using the provider portal website at Illinois Helpline for Opioids and Other Substances (b2clogin.com).

The authorized program administrators must set staff permissions. These permissions are set per organization site, access to other organizations information is not permitted. Information will not be accessible by any other program staff or by any Illinois Helpline staff. Staff who are responsible for current CapMan data entry and any supervisory staff shall register through the Illinois Helpline Provider Portal. The organization shall update their program/site information within the Illinois Helpline provider portal at least once per fiscal year or more often if there is a change to a program description/intake hours/etc.

Reporting shall occur in a manner specified by the Division. The organization agrees to make every reasonable effort to locate and effect referrals to appropriate services for any patient who is specified as a priority service population as described herein, before placing such patient on a waiting list. Organizations shall maintain a documented record system, which includes patient locating information for patients it has placed on a waiting list. This is a federal requirement and may impact your funding associated with this requirement.

Independent Peer Review

Organization with Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG) may be selected to participate in Independent Peer Reviews (IPR). IPR must be completed to comply with Title 45, Subtitle A, Subchapter A, Part 96, Subpart L, 96.136. The IDHS/DBHR will make every effort to minimize the administrative burden associated to increased reviews (e.g., select different organizations every year for peer reviews).

The purpose of independent peer review is to review the quality and appropriateness of treatment services. The review will focus on treatment programs and the substance abuse service system rather than on the individual practitioners. The intent of the independent peer review process is to continuously improve the treatment services to alcohol and drug abusers within the State system. "Quality," for purposes of this section, is the provision of treatment services which, within the constraints of technology, resources, and patient/client circumstances, will meet accepted standards and practices which will improve patient/client health and safety status in the context of recovery. "Appropriateness," for purposes of this section, means the provision of treatment services consistent with the individual's identified clinical needs and level of functioning.

Eligibility - Organization and Patient

Organization Eligibility

To use grant agreement/contract dollars as a payer source for substance use disorder intervention and treatment services, eligibility begins with funding via a fully executed grant agreement/contract with IDHS/DBHR that specifies the types of services that are reimbursable and the rates for these respective services or an approved expense-based budget.

To maintain eligibility, organizations must deliver intervention and treatment services in accordance with IDHS rules that specify:

• The minimum standards necessary to deliver quality care (77 Ill. Admin. Code 2060).
• The minimum standards necessary for administration of funding (Grant Accountability and Transparency Act (GATA), Parts 509 and 511 as well as any other specific obligations, if applicable.

Violations may result in a financial penalty or a disbursement adjustment and are considered in determining the continuation of grant agreements/contracts.

Income Eligibility

Organizations must establish patient income eligibility for use of grant funds to pay for medically and clinically necessary services. Criteria must establish number of dependents and annual income required to access SUPR grant funding. Policies and procedures are to be established for implementation, documentation, and waiver of income eligibility criteria.

• Dependents are defined as the number of dependents living in the patient's immediate household as well as any for whom financial responsibility exists.
• Annual income is defined as all projected annual gross income per calendar year.

All third-party payment benefits, including Medicaid or other state or federal funds, must be identified and accessed first before use of IDHS/DBHR grant funds.

Violations may result in a disbursement adjustment and are considered in determining the continuation of grant agreements/contracts.

Documentation of Income

If IDHS/DBHR funds are used to pay for all or a portion of treatment, the patient must supply documentation of income, which is required to be kept in the patient record or a separate financial record. Acceptable examples of proof of income are a copy of the most recently filed Federal Income Tax Return or any other document indicating current status of family income (i.e., paycheck stubs, W-2 forms, unemployment cards, and Medicare or Medicaid cards). When the organization is unable to secure income verification from the patient, the organization must document in the patient record or a separate financial record what attempts were made to secure such information and the reason for the absence of such information.

Documentation from the patient supporting his or her claim shall be kept in the patient record or a separate financial record. Providers are not required to submit such documentation to IDHS/DBHR, but this information is subject to review. Failure to maintain this documentation will result in disallowance of payments and recoupment.

Co-Payment

Assessment of a co-payment is not allowed for services billed to Medicaid but is optional for an intervention or treatment service that will be reimbursed with IDHS/DBHR grant funds. If an organization elects to assess co-payments, a sliding fee scale and an associated policy and procedure must be developed and reviewed and approved annually by the board of director, all owners or controlling parties of the organization. Collection of the co-payment is the responsibility of the organization.  Inability to collect payment cannot be used as justification for discharge or denial of any intervention or treatment service, including any requested documentation of such services.

Reimbursement Policy

A covered service is that for which payment can be made using grant funds awarded by the Division. Covered services, as specified in this section, must be medically or clinically necessary, as applicable, and delivered in accordance with all provisions specified in 77 Ill. Adm. Code, Part 2060 and/or service requirements specified herein.

Each organization shall have established policy and procedure regarding eligibility, billing, and collection. This policy shall ensure that third-party payment benefits, including Medicaid or other state or federal funds, are identified and accessed first before billing grant funding.

As part of the admission process, organizations are required to ensure that the patient has applied for any applicable entitlement benefit or, if eligible, health insurance under the Affordable Care Act, if such patient is not already enrolled or insured.

Organizations that receive grant funding are expected to also be Medicaid certified by IDHS/DBHR and enrolled by Healthcare and Family Services (HFS) to allow billing for Medicaid covered services. Additionally, organizations funded to provided Medicaid eligible services shall establish and maintain contracts with all Medicaid Managed Care Organizations (MCO) or are expected to refer patients to other appropriately licensed organizations for medically or clinically necessary services the organization does not deliver or when the organization's services are not covered by the patient's MCO or insurance coverage.

IDHS/DBHR maintains the authority to discontinue grant funding to organizations that do not adhere to the IDHS/DBHR contract policy manual, the requirements of Medicaid certification and the billing procedures of Medicaid Managed Care Organizations (MCOs). Compliance with these regulations is essential for the continuation of funding.

Medicare reimburses Opioid Treatment Programs (OTP) for a package of methadone services. Organizations must enroll with and bill Medicare directly for eligible patients. Please find more information at  Medicare Opioid Treatment Program. 

As such, funds contained in SUPR grants shall be used for covered services for income eligible patients when all other applicable entitlement or third-party payment have been depleted. When this occurs, funds can be used as follows:

1. For services for any patient who has exhausted or not yet purchased third-party insurance coverage OR for any annual insurance deductible.
2. For the amount of any applicable Medicaid spend-down and/or for services that are not Medicaid reimbursable.
3. For any patient covered by Medicare who receives services from a IDHS/DBHR licensed organization that cannot enroll as a Medicare provider.

In all cases, no Medicaid eligible services delivered to a Medicaid eligible patient can be reimbursed through IDHS/DBHR  contract funds. This includes claims that HFS or a MCO denies, services that require backdating of Medicaid eligibility or services billed to Medicaid that are past the 180-day reimbursement time frame.

FY 2026 Reimbursement Rates

The rates established to reimburse or calculate earnings represent what the Division has determined it will pay for each service. However, the applicable rate may not always cover the actual cost of the service. When this occurs, it is expected that organizations can demonstrate how the remainder of the cost will be collected to ensure fiscal solvency. Additionally, organizations who serve patients who are not grant eligible, cannot charge such patients LESS than the Department uniform or negotiated rate for that service.

Covered Services and Reimbursement rates for FY 2026 are as follows: 

Reimbursement/Disbursement Specifications

Reimbursement/Disbursement

It is not the Division's practice, or within its ability, to authorize or encourage the delivery of services beyond what the amount of funding contained in the grant agreement/contract can support. Organizations are cautioned against the delivery of unfunded services as this practice may severely affect the delivery of quality clinical care and the organization's fiscal solvency. Services reported as grant services, using the Department's Automated Reporting and Tracking System (DARTS, code DC) at any time during the fiscal year are considered paid for by the amount of funding contained in the grant agreement/contract. Services that you do not want considered in this manner SHOULD NOT BE REPORTED THROUGH DARTS.

Case Management, Early Intervention and Community Intervention Billing Allowance

The Division will allow 25% of the total contract funding for any combination of case management, early intervention, and community intervention services. These base amounts will be supported by edits in the DARTS software and as necessary to ensure that treatment services are the priority for the use of IDHS/DBHR funding.

 Admission and Discharge Assessment

The assessment is a distinct service and is separately reported and billed using the assessment unit/program number, along with the site number where the service was delivered. The admission assessment is delivered using the ASAM criteria to determine the need for services and the level of care placement for those services. An assessment can include the administration of the Eisenberg Disordered Gambling Screening Brief Intervention Referral to Treatment (G-SBIRT) Pre-screen and Screen which each funded treatment organization shall administer. If the gambling screen is positive, the assessment will incorporate the ASAM gambling criteria to diagnose and identify treatment goals. Please note, that the gambling screening is not a Medicaid covered service and can be billed for 15 minutes at the assessment rate to the IDHS/DBHR grant using the L tag. Please see Section 7 of the Service Requirements for additional details. The discharge assessment is delivered to assess progress and any further needs with the patient once the episode of care has been completed.

Group Counseling

Level 1 and 2 services delivered as group counseling shall be reimbursed only for 16 patients per counseling group (Medicaid or grant agreement/contract).

Billings Linked to Level of Care

Billings shall match the Level of Care for the patient. Outpatient care cannot be billed on the same day as Residential care. Case management, psychiatric evaluation, and medication monitoring may be billed on the same day for any patient in any Level of Care in accordance with stated grant agreement/contract conditions, eligibility, limits, or exceptions.

• Level 3 Care - Patient Day - No more than one patient day shall be reimbursed for any recipient in a 24-hour period.
• Day of Discharge or Transfer - Level 3 - Billing for the day of discharge or transfer is not allowable. 

Psychiatric Evaluation

Such services are limited to the provision of a psychiatric evaluation to determine whether the patient's primary condition is attributable to the effects of alcohol or drugs or to a diagnosed psychiatric or psychological disorder. Reimbursable psychiatric evaluations may be delivered to treatment patients where need for such service is documented in the patient's individualized treatment plan. Psychiatric evaluation shall be reimbursed at the established rate on a per encounter basis (one per day). This service must be delivered by the organization's psychiatrist; an enrolled Advanced Practice Nurse (APN) who holds a current certification in Psychiatric and Mental Health Nursing as set forth in 68 Ill. Adm. Code 1300 Appendix A and is practicing in accordance with the Nurse Practice Act; a Licensed Clinical Psychologist (LCP); or a Licensed Clinical Social Worker (LCSW).

Medication Monitoring

Psychotropic medication monitoring is billed at the individual counseling rate for treatment patients. Psychotropic medication monitoring includes a review of the efficacy, dosage and side effects of any psychotropic medication used by the patient. Medication monitoring may be conducted by the agency's physician, physician extender or psychiatrist and billed at the individual counseling rate. Please note, this does not include the monitoring of Medication Assisted Treatment (MAT).

Co-Dependence/Collaterals

• A co-dependent is a family member or significant other of an individual with a substance use disorder. Division funding can be used for assessment of these individuals and for Level 1 services if the assessment resulted in a diagnosis of co-dependent (DSM-5 - Z65. 9).
• A collateral is an individual who receives minimal service because of participation in someone else's related treatment. These services are reported and billed as a treatment service for the patient. If a collateral is seen alone, the service should be billed as an individual session. If any combination of patients and/or collaterals are seen together, each participant should be billed separately under the patient's unique identification number at the group rate. As a guideline, such service should average one contact per week. If need is demonstrated to exceed this average, these types of individuals should be treated as co-dependents.

Case Management

Case management services are individualized and can only be billed while patients are in treatment. They reflect needs identified in the assessment process and services are included in the treatment plan. Organizations should establish clear policies that define the differences between case management and peer recovery support services. Case management that meets the following criteria and is specified below as an eligible service can be reimbursed for a patient in any level of care:

• The service is based upon an identified need, has an identified expected outcome documented in the assessment or the treatment plan.
• The services are documented and integrated in the progress notes. Documentation must show date, time, and duration, and include a brief description of the service provided. The note must be signed by the person providing the service.

Examples of Case Management Activities:

• Assistance with health needs.
• Assistance with transportation but not actual transportation of patients.
• Assistance with childcare.
• Assistance with family situations, living conditions, school, or work situations.
• Inter/intra provider record review.
• Internal and/or external multi-disciplinary clinical staffing.
• Telephone calls, letters, and other attempts to engage family members or significant others in the patient's treatment.
• Telephone calls, letters, home visits to patients to keep them engaged in treatment.
• Assistance with budgeting, meal planning and housekeeping.
• Letters, telephone calls, meetings with employers on behalf of a patient.
• Assist patients and their families in obtaining Medicaid, Social Security, cash grants, WIC, Link Cards, and other entitlements that they may need.
• Assist patients and their families in obtaining medical, dental, mental health, educational, recreational, vocational, and social services as specified in the treatment plan.

Early Intervention

Early Intervention services are authorized by a treatment license, and examples risk factors are as follows:

• Repeated absences, suspensions or terminations from work or school environments.
• Gang Involvement.
• Behaviors leading to involvement with the criminal justice system -e.g., impaired driving, illegal possession of alcohol, cannabis, or illegal substances. 
• Absence from family or home, homelessness, or for youth, running away or placement in alternative living environments or schools.
• Substance use disorder of a family member or significant other that has a regular impact on the client.
• Extreme or prolonged exposure to severe stressor-e.g., loss of home through flood or fire, death of significant other.

Early Intervention services can be provided in an individual or group setting but must be documented in a client record by time, date, and duration.

Community Intervention

Community Intervention is service that occurs within the community rather than in a treatment setting. These services focus on the community and its residents and include crisis intervention, peer recovery support services (pre or post treatment), case finding to identify individuals in need of service including in-reach and outreach to targeted populations or individuals not admitted to treatment and recovery. The requirements for delivery of recovery support services are outlined in Section 12. Outreach is the encouragement, engagement, or re-engagement of at-risk individual(s) into treatment through community institutions such as churches, schools, and medical facilities (as defined by the community) or through consultation with the Division. In-reach is the education of community institutions or state agencies and social services staff regarding the screening and referral of at-risk individuals to treatment programs for a clinical assessment.

Anticipated outcomes of community intervention include an increased awareness, "community ownership" and connectedness between the service system and community institutions. Service visibility will increase. Access to services will increase for all populations but particularly for those earlier in their "problem use" as the public becomes more aware of substance use disorder symptoms and treatment resources. Examples of community intervention activities are as follows:

• Crisis Intervention consisting of brief contacts to determine appropriate interventions and/or services.
• In-reach activities such as meetings with local IDHS or DCFS office staff to discuss screenings and referrals.
• Outreach activities designed to educate community stakeholders and increase referrals for treatment.
• Consultations with referral sources.
• Training, if specific funding for participation in or the delivery of this type of activity is contained within the grant agreement/contract.
• Client/Patient Transportation for case management or treatment activity identified through assessment or in the treatment plan.
• Language interpreter services authorized by a linkage agreement and approved in the Annual Online Certification Plan Survey.

Telehealth

Telehealth can be a valuable tool in the delivery of substance use disorder services by reducing barriers to needed care through a cost-effective alternative to traditional face to face services.

Telehealth can be reimbursed using grant funds and may be reimbursed through other payment sources. Organizations should verify coverage prior to delivery of this service.  Prior to delivery, the organization's Medical Director must approve policies and procedures that assure telehealth services are provided in a safe, confidential, and effective manner. These policies and procedures must describe the types of services provided and how the organization will address issues related to patient safety and security, confidentiality, use of technology, staff training/supervision, and legal issues. Organizations are encouraged to review the Telehealth Capacity Assessment provided by the National Frontier and Rural Telehealth Education Center (NFARtec)(pdf) and TIP 60: Using Technology-Based Therapeutic Tools in Behavior Health Services.

Billing requirements for telehealth are as follows:

• Gambling Disorder, DCFS, collateral, and medication monitoring services are reimbursable.
• Indicate "yes" in the Telehealth Service field on the Service Screen, then use the proper activity code for the service.

Billing for Opioid Use Disorder (OUD) Treatment Services

Any patient receiving OUD treatment must have an open demographic record in DARTS. Billable services are then calculated in DARTS based upon submissions to the Pharmacy Log. If the patient does not have an open demographic record in DARTS, services will not calculate.

OUD treatment services are covered by a weekly case rate. The case rate covers dispensing as well as any other service required by state and federal regulations. Assessment, physical examinations, case management, toxicology, psychiatric evaluations, medication monitoring and substance use disorder treatment can be billed in addition to the case rate.

Funding Specifications

Exhibit F

Exhibit F is part of the grant agreement and contains instructions and information for obtaining the applicable billing unit/program numbers and addresses that indicate all funded services and their associated locations. Standardized rates for each applicable service are specified in this manual. Provider specific rates for residential services will be mailed to each organization at the start of each fiscal year and thereafter if revisions are made. Organizations are asked to review and verify all unit/program numbers, addresses, and rates at the start of each fiscal year and report any discrepancies to the applicable Division grant manager in order to reduce the incidence of data rejection.

Expense-Based Grant Agreements

All expense-based grant agreement expenditures must be submitted to the organization's program Grant Manager, Program Administrator, or Project Director as directed. Monthly Expenditure Payment Vouchers must be submitted through email by the 15th of the month based on the previous month's expenditures using the approved form. All emailed payment vouchers must be a carbon copied  (cc'd) to dhs.suprvouchers@illinois.gov and the email subject line must include the grant agreement award number. All expenditures must be consistent with the division approved program budget and can vary by 10% of the total budget amount which is capped at $50,000.

All categories can only add up to 10% of the total grant amount and is capped at $50,000. Anything above the 10% or $50,000 requires a formal amendment.

For expense-based budgets, budget revision requests are allowed, one per quarter, for the first three quarters. Organizations must work with their Grant Manager, Program Administrator, or Project Director to submit a viable budget revision during the month after the quarter. The division has the authority to reject budget revisions that are not consistent with the scope of a program.

Subawards

Medical/Laboratory Services Purchases

Support service purchases, such as medical/laboratory services, do not require a subaward. The purchase agreement shall address any protocol and/or Administrative Rule requirements/criterion stated within the Division grant agreement/contract and/or this manual related to the service(s) purchased.

Clinical Services Purchases

The requirements for any request to subaward treatment activities funded by the Division are referenced herein. Should the request for a subaward be approved and the organization executes a subaward with another entity to perform treatment or ancillary support, or recovery services identified as deliverables within the Uniform Grant Agreement, the principal vendor must have a signed state fiscal year specific subaward agreement with the entity providing such services. The subaward agreement must be signed and approved by the Division prior to the initiation of any services. Failure to obtain such approval may result in a disallowance of payment as result of voucher reviews, reconciliations, and or post-payment audit reviews.

Subaward Elements

The proposed subaward will be reviewed using at a minimum the items outlined below. Additional information beyond that listed can/may be requested by staff to make a thorough review of the potential subaward. The review of the proposed subaward and any approvals shall address and provide assurance of the following items:

1. Subaward's name, address, phone number, fax number, and email; copies of the applicable Division license for all service sites to be utilized;
2. Copy of all licenses and certifications held by staff, who are performing the treatment, recovery support, or intervention services;
3. Language and copies (attached by Addenda) of the applicable Department Community Services Boiler Plate, Uniform Grant Agreement, and Attachment C, which specify requirements under which the vendor must adhere to as well;
4. Listing of services to be provided;
5. Applicable rates for services to be provided;
6. Location/site where services are to be provided;
7. Applicable Administrative Rules;
8. Applicable federal requirements;
9. Services documentation requirement;
10. Billing requirements/processes for the subaward;
11. Payment processes and agreements;
12. Post-payment audits/monitoring requirements and liability;
13. Renewals, revocations of the grant agreement/contract;
14. Authorized representatives for billing and approval for the subaward; and
15. Annual subaward reconciliation process to be employed.

Billing Requirements

Unique Identification

The Recipient Identification Number (RIN) is required for all client/patients supported by Department funds. A RIN must be requested from the Department, if the client/patient does not have one, prior to billing for any service.

Service Data Reporting (Billing)

Most billing is accomplished electronically utilizing DARTS. Appropriate software containing this system is provided free of charge. A flow chart outlining the steps in the billing process is included with this manual.

A DARTS file is sent to each organization at the beginning of each fiscal year with the billable locations and services for that year. These are sent via email to the organization's Authorized Organization Representative (AOR). This person is responsible for forwarding the file to any staff who needs this to bill. It is also the responsibility of each organization to review the information on the unit/program file and notify IDHS/DBHR of any missing or incorrect information. Throughout the year, any revisions that occur to the DARTS file will also be sent to the AOR. Please note, that only those sites and services approved by the organization's grant manager with IDHS/DBHR will be billable through DARTS. 

Organizations can report DARTS and third-party service data on a weekly basis using file transfer protocol (FTP) but must report data at least monthly. Organizations shall also report any other data so requested by IDHS/DBHR by the prescribed timelines. The preferred method of reporting service data is through software supplied by the Division for any such service that can be reported through this mechanism. The Division assumes no responsibility for late, incomplete, or inaccurate data produced by any software.

An adjustment to future disbursement or a suspension or termination of grant agreement/contract may occur unilaterally and without prior notice if an organization is late reporting any required financial or service data. Disbursement may be reinstated when all data is submitted and approved by the Division. Organizations shall be given immediate notice when such suspension or termination has occurred.

The Division may conduct random reviews to determine accuracy of service data. The organization shall be able to verify data entries upon request. The Division may delay or suspend disbursement or terminate funding immediately without prior notice for late reporting. Late reporting is defined as late for two consecutive months or for any three months during the fiscal year. The Division shall immediately notify the organization that such delay, suspension or termination has occurred.

The organization agrees to notify the Division immediately through a written request to the Help Desk upon discovery of any problem relative to the delivery of or submission of any required service or financial data.

Data Reporting Errors

Services will be rejected for errors in data entry or for errors related to the client/patient's eligibility status. If services are rejected in the Edit and Balance process, the organization will receive this information in an Accepted/Rejected report in Mobius. Organizations shall review these errors to see if correction is necessary and resubmit, if appropriate.

In all instances, if an error occurs and the service can be rebilled, the service shall be resubmitted utilizing DARTS. Please remember that services should be resubmitted as close to the date of the error report as possible.

Monitoring/Audits

The Division monitors the patterns, accuracy, and timeliness of organization reporting to determine compliance with programmatic contractual conditions and conducts post-payment audits to determine compliance with required clinical, administrative, and financial standards. Client, patient, resident and financial records are meant to substantiate compliance. Organizations must establish and maintain audit trails to document services delivered and billed to eligible patients. Financial client, patient and resident record completeness and accuracy are essential for demonstrating compliance and to avoid financial penalty.

Late Payment/Services Submission

The Division has two established billing periods:

• Medicaid Funds: Medicaid funds can be paid if accepted for payment and processed within 180 days of the date of service.
• All Other Division Funds: Any other Division funds can be paid if they are delivered within the applicable state fiscal year, accepted for payment before annually established dates relative to the end of the lapse period and do not exceed the established fiscal year amount of funding contained in the grant agreement/contract.

Payment or Acceptance of Services Beyond Established Billing Periods

Requests for payment or service acceptance beyond established billing periods are allowable if the delay in submission was due to Division or Healthcare and Family Services (HFS) processing.

Requests for service acceptance or reimbursement from Division funds other than Medicaid may only be submitted for the prior state fiscal year. Requests for reimbursement from Medicaid may only be submitted up to two years from the date of service. All requests shall be in writing and include the reason the established billing period was exceeded. Supporting documentation must be attached. All requests must also adhere to the conditions specified in the Division grant agreement/contract, applicable manuals and/or letter of agreement or memorandum of understanding. If the request is for reimbursement from a federal project fund, it must reference the federal grant fiscal year funding as specified in the Division grant agreement/contract. All other requests for reimbursement shall be for the same type of program funds identified in the grant agreement/contract. If the request is denied, it will be for one of the following reasons:

• It is determined that the delay in submission is not the fault of the Division or HFS.
• Insufficient funds to satisfy the request in the specific project or program area.
• No availability of funds within the Division's appropriation authority.
• Failure to comply with billing/reporting requirements.

Federal discretionary projects for the applicable federal project year have been fully expended. Thereby, no funds are available to satisfy the claim. If the request for non-Medicaid funds is approved, the Division will apply the appropriate service credit or approve the services for reimbursement from the Illinois Court of Claims. All such approvals are subject to on-site and/or electronic audit. All requests will be responded to in writing and will specify the reason for the denial or acceptance. If the request is for Medicaid funds, the organization will be required to complete an approved HFS form for each Medicaid claim and send to HFS for processing. All such approvals are subject to on-site and/or electronic audit. All requests will be responded to in writing and will specify the reason for the denial or acceptance.

Payment Inquiry Information

Please follow the process below to review payments made to your organization.

STEP 1
  Go to Illinois Comptroller Vendor payments. 
  Click on "vendor payments" in left column.

STEP 2
  Enter the "Vendor TIN Num" in the field provided.
  Click "OK."

STEP 3
  Click on "Payments."

STEP 4
   "Select a fiscal year."
   "Select an agency."
  Agency "444" is the IL Department of Human Services.
  Click on the "Find Warrants" button.

STEP 5
The left column lists the warrant/EFT#. If the number begins with zeroes, it is an Electronic Funds Transfer (EFT). The funds are deposited directly into the vendor's bank account. Note the "issue date" in the center column. This is the date of the deposit.

STEP 6 
The "Warrant/EFT#" begins with an alpha character. An alpha character indicates that a warrant (check) was issued to the vendor. The "issue date" is the date that the warrant was released. The "paid date" is the date that the warrant cleared. If the "paid date" is blank, the warrant has not been cashed and/or has not cleared.

Double click on the warrant/EFT# for more details regarding the payment.

STEP 7
In the "IOC Accounting Line Details" box, Organization 26 indicates the Division of Substance Use Prevention and Recovery.

Notice the "Invoice" number in the top section. The first digit indicates the State Fiscal Year for which services are being paid. The letters following the first character indicate that this is a payment from IDHS/DBHR. For organization grant/contract payments the alpha characters SA and SB, following the fiscal year number, are the most commonly used by IDHS/DBHR. The last two characters of the invoice number indicate to which month the payment is related.

Medicaid payments will have a different invoice numbering scheme. All Medicaid payments will have an "Object" number of 4560.

Access the following links for information about EFT:

Illinois Comptroller Vendor Services Direct Deposit Step by Step Sign Up (pdf)

Illinois Comptroller Vendor Services Direct Deposit Sign Up

Payment and Data Processing Cycle Flow Chart

Payment and Data Processing Cycle Flow Chart (pdf)

Service Requirements

Introduction

The following are service and deliverable requirements related to primary substance use disorder intervention, treatment and/or adjunct services provided to eligible individuals using Division funding. These expectations are to be considered an extension of the applicable State Fiscal Year grant agreement/contract and will be monitored and reviewed as such. Should you have any questions regarding these requirements please contact the Help Desk at DoIT.SUPRHelp@illinois.gov.

Service Requirements

 SECTION 1:  Service Requirements for Substance Use Disorder Treatment/Ancillary Services/Recovery Services

 SECTION 2:  Service Requirements for Recovery Home Services

 SECTION 3:  Service Requirements for Substance Use Disorder Treatment/Ancillary Services/Recovery Services for DCFS Recipients

 SECTION 4:  Service Requirements for Toxicology Testing for Assessment, Placement Decisions, or Treatment Planning for Substance Use Disorders

 SECTION 5:  Service Requirements for Opioid Use Disorder Treatment Services (OTP)

 SECTION 6:  Service Requirements for Toxicology Testing for Patients in Opioid Use Disorder Treatment Services

 SECTION 7:  Service Requirements for Gambling Disorder Services

 SECTION 8:  Service Requirements for Substance Use Disorder Treatment Organizations That Provide Daytime Childcare and Child Domiciliary Services

 SECTION 9:  Service Requirements for Pregnant Women and Women with Dependent Children (PWWC) Designated Sites

SECTION 10: Service Requirements for Bureau of Prevention Services Funded Organizations

SECTION 11: Service Requirements for Stabilization and Transition Services (ST) - NEW

SECTION 12: Service Requirements for Peer Recovery Support Service

SECTION 1:  Service Requirements for Substance Use Disorder Treatment/Ancillary Services/Recovery Services

Target Population: Individuals in Need of Substance Use Disorder Treatment, Adjunct Treatment, or Recovery Services.

Introduction: These requirements set forth the terms and conditions applicable to substance use disorder treatment and related services funded by the Division of Behavioral Health and Recovery.

Specific Administrative Rules

Treatment services are to be provided according to Administrative Rule: Title 77: Public Health Chapter X: Department of Human Services Subchapter D: Licensure Part 2060 Substance Use Disorder Treatment and Intervention Services.

Levels of Care to be Provided or Made Accessible

Introduction: Early Intervention and Treatment services are to be provided according to Administrative Rule: Title 77: Public Health Chapter X: Department of Human Services Subchapter d: Licensure Part 2060 Substance Use Disorder Treatment and Intervention Services.

Treatment shall be made accessible to individuals screened and assessed for need based upon the most current American Society of Addiction Medicine (ASAM patient placement criteria. This accessibility shall be directly provided by the organization or by direct referral and linkage to an alternate organization who is able to provide such service.

ASAM Assessment

Assessments precede admission to treatment and then is ongoing throughout treatment as continuing service review. The initial goal of assessment is to obtain sufficient information to determine the need for stabilization, obtain a diagnosis, and an initial recommendation for placement in a level of care so that the patient can access and initiate services as soon as possible.

Assessment is conducted in accordance with the six dimensions of the ASAM Criteria and includes the biopsychosocial assessment and risk/severity rating and an immediate need profile. The apparent severity of the patient's condition and impairment shall guide how comprehensive the initial biopsychosocial assessment for placement needs to be prior to admission.

Assessment is a clinical service and shall be conducted by professional staff.

Assessment shall include a review of any specific conditions or recommendations from a referral source including any prior screenings, evaluations, or assessments.

Assessment shall include a review of any specific conditions of any court order or other referral that may require completion of a specified level of care or number of hours. If a court order or referral differs from the level of care or number of hours that are subsequently determined by the assessment, the organization shall have procedures in place to reconcile with the court or referral source and allow admission in accordance with the requirements specified in 77 Ill. Admin. Code 2060.450 regarding mandated treatment.

The assessment shall be organized according to the six dimensions of the ASAM Criteria and conclude with a diagnosis, as defined in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), and a recommendation for placement in a level of care. The level of care provided shall be in accordance with that specified in the ASAM Patient Placement Criteria and with the following services definitions and requirements:

Levels of Care

Any staff person who delivers clinical treatment services as defined in 77 Illinois Administrative Code, Chapter X, 2060.410 or early intervention services as defined in Section 2060.405.

1. Early Intervention: Early Intervention can reduce the effects of use within the targeted community by identifying and engaging those in need of services. Early Intervention shall be provided to an identified individual (in an individual or group setting) and documented in a client record and shall be earned utilizing non-Medicaid funds at the established Early Intervention individual and group rates. The length of such service varies according to the individual ability to comprehend the information provided and to use that information to make behavior changes to avoid problems related to substance use or the appearance of new problems that require treatment at another level of care. Examples of individuals who might receive early intervention are at-risk individuals (i.e., family members of an individual who is in treatment or in need of treatment) or DUI offenders classified at a moderate risk level.
2. Level 1: Outpatient: Non-residential treatment consisting of clinical services for adults or adolescents. The frequency and intensity of such treatment shall depend on patient need but shall be a planned regimen of regularly scheduled sessions  that complies with the ASAM criteria for applicable Level 1 care.
3. Level 2: Intensive Outpatient/Partial Hospitalization: Non-residential treatment consisting of clinical services for adults or adolescents. The frequency and intensity of such treatment shall depend on patient need but shall be a planned regimen of scheduled sessions that complies with the ASAM criteria for applicable Level 1 care.
4. Level 3.1 - Clinically-Managed Low Intensity Residential - Low intensity clinical services that include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning in a residential setting. Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning. Historically referenced as halfway houses or residential extended care, organizations shall identify, through administrative policy, staff/patient ratios that ensure patients can access all recommended hours of treatment. Level 3.1 requires staff, awake and on duty, 24-hours a day, seven days per week, with clinical services delivered by professional staff at least five hours per week that primarily focus on the application of recovery skills, relapse prevention, and emotional coping strategies. Services are most appropriate for patients who need time and structure to practice and integrate their recovery and coping skills in a residential supportive environment.
5. Level 3.5 - Clinically-Managed Medium to High Intensity Residential Services - Level 3.5 care requires staff, awake and on duty, 24-hours a day, seven days per week. Clinical services range from medium to high intensity in a residential setting and organizations shall identify, through administrative policy, staff/patient ratios that ensure patients can access all recommended hours of treatment. Services include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning. Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning. Level 3.5 services are tailored to the patient's readiness to change and are most appropriate for patients whose SUD is so severe that it requires a 24-hour supportive treatment environment to initiate or continue a recovery process that has failed to progress. Services help patients stabilize and focus on the development of recovery skills so that they do not immediately continue to use in an imminently dangerous manner upon transfer to a less intensive level of care. Lengths of services are variable with services designed to support ongoing recovery rather than resolve all identified social and psychological problems. Clinical services must be offered daily and average a minimum of 25 hours per week, 7 days per week, over the length of stay.
6. Level 3.7 - Medically-Monitored Inpatient Withdrawal Management - Level 3.7 care requires staff, 24-hours a day, awake and on duty, seven days per week, who meet the requirements specified in 77 Ill. Admin. Code 2060.320(c). This level of withdrawal management allows for the induction or stable dose of MAR or withdrawal from a licit or illicit substance with no MAR if that is not indicated or per patient preference. All services are delivered primarily by medical and nursing professionals for patients whose withdrawal signs and symptoms are sufficiently severe to require 24-hour evaluation in a residential setting. Medical services are delivered under a defined set of physician-approved and -monitored procedures or protocols. Clinical services include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning. Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning. Level 3.7 services focus on stabilization until withdrawal signs and symptoms are sufficiently resolved and the patient can be safely managed at a less intensive level of care or, conversely, referred for more acute medical management in an inpatient setting.

Ancillary Services, Ancillary Treatment

Intervention or Support Services

These services are defined and have the following services protocols:

1. Toxicology: Urine, blood, or saliva analysis to determine the presence of alcohol and/or other drugs in patient/clients who receive treatment or intervention services.
2. Case Management: A coordinated approach to the delivery of health and medical treatment, substance use disorder treatment, mental health treatment, and social services, linking patients with appropriate services to address specific needs and achieve stated goals. Services may occur in the home or in other community environments and are for patient engagement and retention in treatment. Case management must be individualized to the specific patient as reflected by an individualized assessment and contained within the treatment plan. Case management may begin with admittance to treatment and proceed through continuing care. All funded case management must be documented in the patient record so that a post-payment audit can confirm the delivery of reported services.
3. Community Intervention: A service that occurs within the community rather than in a treatment setting. These services focus on the community and its residents and include crisis intervention, case finding to identify individuals in need of service including in-reach and outreach to targeted populations or individuals not admitted to treatment. Outreach is the encouragement, engagement, or re-engagement of at-risk individual(s) into treatment through community institutions such as churches, schools, and medical facilities (as defined by the community) or through consultation with Illinois Department of Human Services divisions. In-reach is the education of community institutions or state agencies and social services staff regarding the screening and referral of at-risk individuals to treatment programs for the purposes of a clinical assessment. All Community Intervention services shall be earned in staff hours utilizing non-Medicaid funds at the established Community Intervention rate. All funded community intervention must be documented by time, date, and duration so that a post-payment audit can confirm the delivery of reported services.
4. Recovery Home: Services as specified in 77Ill. Admin. Code2060.540 and/or in this manual Service Requirements Section 12.
5. Medications: Limited reimbursement for the cost of medications for organizations who deliver substance use disorder treatment.
6. Interpreter Services: These are sign and other technology services provided for individuals with a Deaf or Hearing Impairment. These services are for all levels of treatment, adjunct, and recovery services for these individuals.
7. Psychiatric Evaluation: An evaluation of a patient and exchange of information to determine whether the patient condition is because of alcohol and/or other drugs or a diagnosed psychiatric disorder.
8. Medication Monitoring: Counseling to review a patient use of medications while in treatment that is conducted by the organization psychiatrist, physician, or physician extender as a part of an individual counseling session.
9. Specialized Services/Projects: The provision of special or unique projects. Descriptions are specified in a provider unique grant agreement/contract via the scope of services section of the applicable IDHS Uniform Grant Agreement.
10. Recovery Support Services: Non-clinical services designed to support individual recovery from a substance use disorder that may be delivered pre, during, or post treatment. These services are generally delivered by a peer (someone who has their own lived or living experience of recovery) with the client in a wide variety of settings to support the individual in meeting his or her recovery support goals, and include employment training, continuing care, employment coaching, peer recovery coaching, recovery coaching, recovery skills, spiritual support, health & wellness, harm reduction, social support, referral & linkage, community outreach & engagement, and transportation.

Tuberculosis (TB) Education for SUD Patients: DARTS Billing Requirements

77 Ill. Admin. Code 2060 requires all patients receiving services from a licensed IDHS/DBHR organization receive tuberculosis (TB) education. For those organizations that also have Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG) funding, it is required that these services be reported correctly through DARTS for IDHS/DBHR to demonstrate compliance for continued SUPTRS BG funding.

For any person who receives early intervention, outpatient or intensive outpatient services (level 1 and Level 2), activity code 10 should be tagged to identify the individual or group session where this information was presented. Patients in Level 3 care should also receive this education, although there is no mechanism to report this education separately from the daily rate. Therefore, please ensure that all TB education is properly documented in the client/patient record.

SECTION 2:  Service Requirements for Recovery Home Services

Target Population: Individuals assessed as in need of Recovery Home services.

Introduction: These requirements set forth the terms and conditions applicable to Recovery Home services funded by the IDHS/DBHR for individuals recovering from a substance use disorder. Services include housing, intermittent staff support and/or access to ancillary self-help group, or skill building activities, which assist in obtaining or help maintaining a lifestyle free of a substance use disorder.

Administrative Rules/Guidelines

Recovery Home services are to be provided according to Administrative Rule: Title 77: Public Health Chapter X: Department of Human Services Subchapter D: Licensure Part 2060 Substance Use Disorder Treatment and Intervention Services. Section 2060.540 Recovery Homes.

Recovery Home Specific Programmatic/Service Requirements

1. The organization shall ensure that all individuals receiving Recovery Home services funded by this award have a substance use disorder diagnosis.
2. The organization shall ensure that all individuals receiving Recovery Home services are sufficiently stable and are actively seeking assistance in obtaining or help maintaining an illicit drug and alcohol-free lifestyle. Assistance can include but is not limited to 12-step groups, faith-based recovery activities, or other sobriety-based activities/groups that meet the specific social or cultural needs of the individual.
3. The organization shall maintain on site an individualized client record, which includes at a minimum:
   1. Documentation supporting that the individual is in recovery from a substance use disorder and needs Recovery Home services;
   2. An individual recovery plan that contains goals and objectives that, at a minimum, identify steps to secure stable permanent housing, needed support services/activities, and employment/vocational development/skill building objectives. The recovery plan should be reviewed as needed to meet individualized recovery needs and meet the requirements in 77 Ill. Admin. Code 2060.540(c)(6). The plan shall address how the recovery plan will build supports within the resident's "home living" environment and how the resident will access additional treatment services if needed; and
   3. Documentation of any involvement in the Recovery Home's organized activities, and access and utilization of natural supports, community-based agency support or other services needed to assist in maintaining the individual recovery plan. Documentation shall also include the organization's contacts regarding recovery support services collaboration and supports accessed to support the individual's recovery plan while in residence and post discharge (when possible). Such documentation includes scheduled appointments (medical and/or other), linkage agreements, and recovery services provided to house residents.
4. The organization shall adhere to all requirements specified in 77 Ill. Admin. Code 2060.350 pertaining to Confidentiality of Patient Information, 2060.370, pertaining to recordkeeping requirements and Part 2060.540. relative to Recovery Home services.
5. The organization shall ensure that staff, providing any type of service for a child or adolescent receiving childcare at the Recovery Home, or residing at the Recovery Home with a parent who is a resident, consent to a background check to determine whether they have been indicated as a perpetrator of child abuse or neglect in the Child Abuse and Neglect Tracking System (CANTS), maintained by the Department of Children and Family Services as authorized by the Abused and Neglected Child Reporting Act [325 ILCS 5/11.1(15). This background check shall also include utilizing the Law Enforcement Agency Data System (LEADS) maintained by the Illinois State Police. The organization shall have a procedure that precludes hiring of indicated perpetrators based on the reasons set forth in 89 Ill. Adm. Code 385.30(a) and procedures wherein exceptions will be made consistent with 89 Ill. Adm. Code 385.30(e) and procedures for record keeping consistent with 89 Ill. Adm. Code 385.60.
6. The organization shall have documentation of a written emergency plan and practices which meets the requirements of 77 Illinois Administrative Code, Chapter X; Part 2060.310(f)(h), 2060.375.
7. The organization shall have a quality improvement plan, which has documentation of goals, quarterly measures, and reviews of objectives, anticipated outcomes, and results of annual services improvement activities/actions.
8. All required documented information shall be made available to the Department upon request.
9. The organization must assure no bedroom is in an attic or in an area with floor more than three feet below the adjacent ground level.
10. The organization shall attend and participate in Division sponsored meetings, training and technical assistance targeted to Recovery Home organizations. The organization shall be notified of requests to participate and shall be responsible for all related travel expenses. The organization shall provide staff development training at least annually. These sessions shall include education on cultural competency, awareness, sensitivity, and limited English-speaking services.
11. The organization shall maintain board approved policies and procedures regarding the use of volunteers for any in-kind staff coverage, house monitoring, house support staff, or house maintenance staff, and annually renewed volunteer agreement. Such agreement shall cover administrative operation policies and procedures, confidentiality requirements, and all personnel policies applicable to paid staff as well as in-kind staff volunteers.
12. The organization shall not utilize active clients as in-kind volunteers for the program and may not submit any billing for Recovery Home per diem services for volunteer house managers/monitors.
13. If routine or random toxicology testing is utilized, the organization shall have written policy and procedure that, at a minimum, identifies the method to obtain informed consent from each resident regarding routine and random toxicology. This informed consent shall state the purpose of such testing, the frequency of routine testing, the causative factors for random testing and the consequences of test results that indicate the presence of alcohol and/or other illicit drugs. This informed consent must be signed by the client prior to acceptance into the residence and maintained in the client record.
14. All funded recovery homes shall have all staff as well as clients receive opioid overdose education and training that includes how to recognize an overdose and instruction on how to administer naloxone, a life-saving medication used to reverse a suspected opioid drug overdose. Organizations must also certify that naloxone is readily accessible and distributed to all staff and clients at each recovery home. Additional information and training resources can be accessed at IDHS/DBHR Drug Overdose Prevention Program (state.il.us).

Additional Recovery Home Programmatic/Service Requirements for Adolescent

Adolescent recovery homes are required to be a stand-alone home or have a physically separate area dedicated specifically for adolescents. This separation from adults is essential to ensure the safety and well-being of young individuals in recovery. The designated space should be clearly marked and designed to create a supportive and safe environment tailored to the needs of adolescents. All IDHS/DBHR licensed and funded recovery homes who provide services to adolescents must follow all rules specified in Part 2060.540, and:

1. Section 2060.200 Capacity and Organizational Readiness:
   1.  Demonstrate sufficient capacity and fiscal, administrative, and organizational readiness to deliver SUD intervention services safely and effectively, and in a manner consistent with evidence-based and developmentally- and culturally appropriate practices.
2. Section 2060.330 (b)(8) Staff Development and Training Requirements:
   1. . Complete a review of the mandatory reporting requirements as specified by the Illinois Department of Children and Family Services (DCFS) and how those requirements relate to job specifications and any applicable professional staff, including paid/unpaid interns or volunteers.
3. Section 2060.335 (j) Personnel Requirements and Procedure:
   1. Upon hire, and prior to every license renewal cycle, the organization shall perform background checks for all employees, contractual employees, volunteers, and interns. At a minimum, the review shall include:
      1. Conducting a background check using the free online National Sex Offender Registry at https://www.nsopw.gov/ for all staff;
      2. Conducting an additional background check using the Child Abuse and Neglect Tracking System (CANTS), maintained by the Illinois Department of Children and Family Services (DCFS) and authorized by the Abused and Neglected Child Reporting Act [325 ILCS 11.1(15)] for any staff that have contact with children or adolescents or provide clinical services or any other supportive services for a child or adolescent who is receiving intervention or treatment, or is receiving childcare at a facility or is residing at a facility with a parent receiving intervention or treatment services;
      3. Complying with a procedure that precludes hiring of persons based on the reasons specified in this Section and as set forth in 89 Ill. Adm. Code 385.50(a) and of those convicted of, or with pending charges of, crimes as set forth in 89 Ill. Adm. Code 385.60(a).  The organization shall also have and follow procedures allowing for waiver of these restrictions based on 89 Ill. Adm. Code Sections 385.50(b), 385.60(d) through (e), and 385.70(b); and
      4. Complying with policies and procedures to ensure the protection of other staff or client/patient/residents during the interim between initial submission of the staff background check and obtaining the results.  These policies must identify any staff limitations regarding the delivery of SUD intervention services during this interim.  The organization is responsible for all such hiring and service delivery decisions and the results thereof and for following recordkeeping procedures consistent with 89 Ill. Adm. Code 385.90.
4. Organizations licensed to provide recovery home services to adolescents must also adhere to the following requirements:
   1. Safety Requirements:
      1. Services and sleeping quarters are segregated by age (adult or adolescent), except for parents and/or guardians and their children/adolescents.
   2. Adolescent Safety Standard Operating Procedures (ASSOP):
      1. Establish an ASSOP that ensures the safety of adolescents receiving services in the same facility as adults. Upon hire, and annually staff are trained in the ASSOP.
   3. Staffing Requirements:
      1. Recovery homes serving adolescents shall employ a minimum of seven staff to ensure at least one staff person is present when the residents are in the Recovery Home including weekends and holidays. The organization shall further ensure that at least two of these seven staff are in management/supervisory roles and meet all professional requirements specified in 77 Illinois Administrative Code, Chapter X, Part 2060.320(i).

Specific Reporting Requirements

The Recovery Home must maintain a daily attendance and activity log for each site signed daily by each resident and staff. For auditing purposes, this log must have original signatures. These signatures shall serve as confirmation of the resident's presence at the Recovery Home and/or be considered original source/records data to support services reporting/earnings.

SECTION 3:  Service Requirements for Substance Use Disorder Treatment/Ancillary Services/Recovery Services for DCFS Recipients.

Target Population: Individuals and family members who are being served by the Illinois Department of Children and Family Services (DCFS) that meet the following criteria:

• Parents or other adults with an open DCFS case, assigned to either a DCFS or Purchase of Service (POS) agency caseworker;
• Individuals Identified by the DCFS Integrated Assessment process, the Clinical staffing process, DCFS Recovery Coach referrals, or Family Advocacy Centers;
• Any Individual who has been screened and referred as part of a DCFS investigation;
• DCFS involved youth under age 18 and older adolescents and young adults through age 21; and
• The client may be the mother, father, relative or collateral (not a blood relation) member of the household who is affecting the decision regarding a child's placement; or may be the child or children, including DCFS youth in care for whom the DCFS case was opened.

Introduction: These requirements set forth the terms and conditions applicable for substance use disorder treatment and related services funded by the IDHS/DBHR for substance use and gambling services.

Specific Administrative Rules

Administrative Rule: Title 77: Public Health Chapter X: Department of Human Services Subchapter D: Licensure Part 2060 Substance Use Disorder Treatment and Intervention Services.

Administrative Requirement/Reporting

Reporting: The organization shall complete, via a format approved by the Division and DCFS, a patient progress report monthly for each DCFS patient while the patient is receiving treatment. The completed report is to be forwarded to the patient's assigned DCFS or Purchase of Service (POS) caseworker every 30 days and at the time of discharge from treatment and/or recovery support services. The organization shall maintain a copy of the report in the patient record. A discharge summary is also to be completed and forwarded to the caseworker upon discharge.

Training and Staff Requirements: The organization shall participate fully in cross training events or other related meetings arranged, convened and/or endorsed by the Division. Organizations shall also send program representatives to regional partnership meetings. As required by IDHS/DBHR licensing regulations (77 Illinois Administrative Code, Rule 2050.313 d), a Child Abuse and Neglect Tracking System (CANTS) check shall be conducted on all new and existing personnel.

Investigations: Organizations shall cooperate with any DCFS child abuse and neglect investigations as well as investigations conducted by the DCFS Child Death Review Teams or the DCFS Office of the Inspector General as requested and appropriate.

Target Population Specific Service Requirements

1. The organization shall receive from the client's caseworker a completed a DCFS Referral packet; the packet must include the Adult Substance Abuse Screen (CFS 440-5), Referral for SUD Treatment Services (CFS 440-6), and/or Youth Alcohol and other Drug Abuse Indicators (CFS 440-8) and the Consent for Disclosure - Substance Abuse Assessment or Treatment (CFS 440-7).
2. The organization shall participate in joint case staffing with DCFS and POS staff.
3. Except for individual cases where circumstances may prohibit, the organization shall conduct an assessment within five (5) days of receiving a referral. The referring agency shall be informed on a timely basis when the referred patient does not keep an appointment for an assessment and/or outreach services, as defined herein.
4. The organization shall provide interim services for DCFS-involved clients for whom the recommended treatment modality is not currently available.
5. The organization shall deliver outreach services to all DCFS involved patients as appropriate to sustain gains made in treatment and/or recovery support services. The provision of outreach services will vary based upon patient need and the level of care provided.
6. The organization shall assure that all DCFS involved patients receive parenting training approved by DCFS.
7. The organization shall address the transportation needs of DCFS involved patients receiving outpatient treatment services.
8. The organization shall assist in meeting the childcare needs of DCFS patients when receiving outpatient treatment services. On-site or off-site childcare arrangements are allowable.
9. The organization shall establish and maintain linkage agreements with local agencies to help secure any necessary mental health, substance use, domestic violence, childcare or housing needs for DCFS patients. Patient referrals to organizations providing the services should be documented in the patient record.
10. If child domiciliary services are provided, such services must be in accordance with the Service Requirements Section 8: Service Requirements for Substance Use Disorder Treatment Organizations that Provide Daytime Childcare and Child Domiciliary Services.

Treatment Intervention and Recovery Support Services to be Provided: All treatment levels of care specified in 77Ill. Admin. Code 2060.401 shall be made accessible to individuals screened and assessed for need based upon the most current ASAM patient placement criteria. This accessibility shall be directly provided by the organization or by direct referral and linkage to an alternate service organization who is able to provide such service including Recovery Community Organizations (RCO). All licensed intervention services shall meet the requirements specified in 77 Ill. Admin. Code 2060. Subpart E.

ASAM Patient Assessment: Treatment shall be offered in varying degrees of intensity based on the level of care and the subsequent treatment plan developed for that patient. The level of care and/or recovery support services provided shall be in accordance with that specified in the ASAM Patient Placement Criteria and with the service definitions and protocols specified in Section 1 and 2 of this manual.

SECTION 4:  Service Requirements for Toxicology Testing for Assessment, Placement Decisions, or Treatment Planning for Substance Use Disorders

Target Population: Patients receiving substance use disorder treatment services (assessment, placement decisions, or treatment planning).

Introduction: These service requirements for funded toxicology services are applicable to treatment and related services for organizations funded by the IDHS/DBHR. Such funds are not intended to guarantee or cover 100% of the organization's toxicology requirements. Toxicology services shall be used solely for assessment, placement decisions, or treatment planning and must at a minimum meet the requirements specified herein. Toxicology services that could result in adverse criminal or administrative actions must as applicable, also meet the requirements specified in Section 6: Service Requirements for Toxicology Testing for Patients in Opioid Use Disorder Treatment.

1. Organizations shall either 1) contract with a CLIA certified laboratory or 2) operate a laboratory approved by the U.S. Department of Health and Human Services (Clinical Laboratory Improvement Standards (CLIS)) or 3) if the organization chooses to use "Point of Care" testing/procedures that have low risk of an erroneous result, the organization shall apply for and maintain a Clinical Laboratory Improvement Amendments (CLIA) Certificate of waiver as outlined in federal regulation CFR Title 42 - Public Health/Part 493 (Laboratory Requirements)/Sections 493.35 (Application for a certificate of waiver) and 493.37 (Requirements for a certificate of waiver).
2. Definition: Point of Care Testing is defined as testing administered at the location of the patient.
3. Organizations shall have policies for toxicology testing that contain the following:
   1. The type, purpose, and limitations of their toxicology testing;
   2. Procedures for ensuring compliance with applicable federal, state, and local laws;
   3. Procedures for ensuring compliance with specific testing requirements;
   4. Procedures for toxicology testing documentation and billing; and
   5. Procedures for personnel training and quality improvement.
4. The rate of payment for toxicology services is identified in the current state fiscal year Contractual Policy Manual.
5. If the organization submits any patient identifying information with the toxicology samples to an outside vendor, the organization must have an annually renewed business associate agreement on file which addresses all HIPAA and 42 CFR confidentiality requirements.
6. If the organization enters into a purchase of services agreement with an outside vendor for toxicology laboratory services, the organization must maintain a business/services agreement with the vendor that assures adherence to the requirements herein, including maintaining a copy of the vendor's valid CLIA certification.

Specific Reporting Requirements

To receive reimbursement, the provider shall report all toxicology services using the current State Fiscal Year version of the DARTS software. 

SECTION 5:  Service Requirements for Opioid Use Disorder (OUD) Treatment Services (Opioid Treatment Program)

Target Population: Patients with an Opioid Use Disorder (OUD) diagnosis.

Introduction: These requirements apply to services funded by IDHS/DBHR for patients with an Opioid Use Disorder diagnosis. Required services include substance use disorder treatment, medication, physical examinations, toxicology, and any other applicable state and federal regulations.

Organizations are responsible for conducting ongoing self-sufficiency surveys to determine continued patient eligibility for state-funded services. The provider shall not charge funded patients any separate admission, application, evaluation, or registration fee.

Administrative Rules

State

1. All services must be provided in accordance with: Title 77: Public Health Chapter X: Department of Human Services Subchapter D: Licensure Part 2060 Alcoholism and Substance Use Disorder Treatment and Intervention Services.

Federal

2. Organizations shall comply with Federal Guidelines for Opioid Treatment Programs: Title 42 of the Code of Federal Regulations (42 CFR) Part 8 (89 FR 7549, Feb. 2, 2024, unless otherwise noted).
3. The organization shall conduct, record, and maintain biennial inventories of narcotic drug stocks as specified in 21CFR1304.11(c).
4. The organization shall execute, process, and maintain DEA Form 222 as specified in 21CFR1305.
5. The organization shall maintain current Power of Attorney for DEA Form 222 as specified in 21 CFR1305.07 and shall revoke Power of Attorney for former employees.
6. The organization shall maintain physical security controls as specified in 21CFR1301.72.
7. The organization shall satisfy all applicable requirements under 42 CFR 8 Substance Abuse and Mental Health Services Administration (SAMHSA) including accreditation and 21CFR1301-1307 (DEA) specific to the treatment for OUD and the delivery, storage, security, and accountability of methadone. Documentation of SAMHSA approval, DEA registration, and accreditation must be maintained on-site and be available to DBHR staff on demand. The organization shall notify DBHR immediately upon any change or delay in accreditation status.

Administrative Requirements

1. The organization shall have a designated Authorized Organization Representative and Medical Director.
2. The award total has been calculated by multiplying the weekly reimbursement rate by the number of cases funded by 52 weeks.
3. The rate covers the following components: 1) managing the medical plan of care; 2) ordering the drug; 3) nursing services related to administration; 4) administration of the drug; 5) coordination with other substance use disorder services; and 6) actual drug cost per dose.
4. The initial medical examination, additional medical services rendered by a practitioner, toxicology services, psychiatric evaluations, assessment, case management, medication monitoring, and substance use disorder treatment are reimbursed separately when the services are medically necessary and meet all requirements specified in Administrative Rule, Part 2060 and the Medicaid State Plan.
5. The organization shall forward to the Division, as the State Methadone Authority, copies of all Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (CSAT) approved accrediting body survey reports, organization responses to these surveys, accrediting body responses and subsequent documentation of accrediting body awards or denials. (Organizations may give permission for CSAT-approved accrediting bodies to forward their surveys and documentation of awards or denials directly to the State Methadone Authority. Otherwise, the responsibility to forward these required documents rests with the individual organization.)
6. Organizations with Automated Dispensing Machines are responsible for:
   1. Calibrating the machine on a weekly basis according to manufacturer procedures/specifications.
   2. Limiting access to medical order entries, i.e., changes in dosage and pickup orders, to licensed physicians only.
   3. Printing daily activity reports for patient dispensing, bottle control, and no shows.
   4. Taking physical drug inventories and updating the machines daily.
   5. Printing all reports as requested by monitors and the State Methadone Authority.

Documentation

1. The organization shall maintain on-site and on an ongoing basis, the "Daily/Weekly Medication Accounting Sheet" and the "Exception Medication Record." These records may be maintained electronically.
2. The organization shall maintain records as specified in 21CFR1304 and 42 CFR § 8.12(g).
3. The organization shall submit opiate dispensing information to IDHS, Unified Health Systems, utilizing the approved IDHS interface, on a weekly basis.
4. The organization shall submit all closings to the Division as follows: within one month after a patient has completed or been transferred, patients in outpatient treatment within 30 days of having no contact and patients in residential treatment within three (3) days of having no contact. The discharge record shall include completion of the National Outcome Measures (NOMS) fields. The organization shall submit opiate dispensing information to IDHS, Unified Health Systems, utilizing the approved IDHS interface, on a weekly basis.
5. All services documentation must be kept as required by Part 2060.325 Patient/Client Records and/or written correspondence from the Division.

Target Population Specific Requirements Regarding Dosing Services

Opioid Use Disorder (OUD)Treatment Specific Dosing Service requirements are:

1. Organizations shall comply with the requirements established for the screening and physical examination of patients, as outlined in Organizations must comply with Federal Guidelines for Opioid Treatment Programs: Title 42 of the Code of Federal Regulations (42 CFR) Part 8 (89 FR 7549, Feb. 2, 2024, unless otherwise noted).
2. The organization shall ensure that all patients are seen by a Physician and receive a physical examination conducted by a Physician or Physician Extender prior to admission to treatment and ingestion of the initial dose of Methadone. Physician Extenders, i.e., Physician's Assistants (PAs) and Advanced Practice Nurses (APNs), and Nurse Practitioners (NPs) may conduct the actual physical examination.
3. The organization shall also ensure that no fewer than eight random drug tests or analyses are performed on each patient each year.
4. Upon completing 31 days in treatment, the take-home supply provided to a patient is not to exceed 28 days. It remains within the OTP practitioner's discretion to determine the number of take-homes up to 28 days.
5. Each organization shall be responsible for all programmatic requirements involving continuing treatment.

Medication Exceptions

1. The organization shall have a policy regarding take-home medication, in accordance with SAMHSA regulations and exceptions to policies regarding take-home supply of medication prior to implementation. The organization shall request and have appropriate CSAT approvals for any policy exceptions to regulations as well as all policies regarding supplies of take-home medication.
2. An exception may be made to the take-home supply of medication policy, which permits a temporary or permanently reduced clinic attendance schedule, if in the reasonable clinical judgment of the organization's physician:
   1. The patient has been found to be responsible in handling narcotic drugs and has a physical disability which interferes with his or her ability to conform to the applicable mandatory clinic attendance schedule; or
   2. The patient has been found to be responsible in handling narcotic drugs and has exceptional circumstances, such as illness, family crises, travel, or other hardship.
3. The rationale for each exception and the physician's approval must be entered into the patient record.

SECTION 6:  Service Requirements for Toxicology Testing for Patients in Opioid Use Disorder (OUD)Treatment

Target Population: Patients receiving Opioid Use Disorder Treatment.

Introduction: These service requirements are for funded toxicology services applicable to treatment and related services for organizations funded by the IDHS/DBHR. Such funds are not intended to guarantee or cover 100% of the organization's toxicology requirements.

Requirements:

1. The number of panels specified herein is the minimum expectation. The actual number may vary based upon the negotiated costs of each panel and the needs of each organization. The organization must test for the minimum number of panels as described.
2. The organization shall negotiate the following with the laboratory of the organization's choice:
   1. The choice of testing medium (urine, sputum or sweat) to be used for the toxicology test;
   2. Which five drugs will comprise the standard testing panel;
   3. The cost of each panel;
   4. Onsite versus laboratory testing;
   5. Collection techniques;
   6. The cost and frequency for confirmation testing; and
   7. Any other issues related to toxicology testing for the five drugs comprising the standard testing panel.
3. OUD Treatment organizations shall ensure that all testing includes, at a minimum, five drugs: one of which must be methadone. It is suggested that tests for Amphetamines and Barbiturates not be routinely requested unless clinically indicated due to the minimal use historically reported by programs. Instead, tests providing more realistic value such as Benzodiazepines, Marijuana, and PCP should be more routinely requested. Additionally, the organization shall ensure that it can test for six (6) Monoacetylmorphine - 10 ng/ml.
4. The organization shall contract with a laboratory or operate a laboratory that meets the following specified criteria upon the initiation of and through the term of the contract:
   1. Maintain and provide documentation supporting approval from the U.S. Department of Health and Human Services (Clinical Laboratory Improvement Standards (CLIS)).
   2. Participate in one or more of the following controlled programs:
      1. College of American Pathology Advanced Toxicology Survey.
      2. American Association of Forensic Science Toxicology Survey.
      3. Certification for laboratory testing eligibility for Medicare.
   3. Ensure that the chain of custody (COC) is maintained on all specimens.
   4. Test all specimens for adulteration prior to the initial screening test. The laboratory shall test each urine specimen for pH (less than 3 or greater than 11), and/or specific gravity (less than 1.001 or greater than 1.020). When a specimen is adulterated, the laboratory shall notify the organization within 48 hours of receipt of the specimen. The laboratory shall not test an adulterated specimen. (If the organization uses a medium other than urine (i.e., sputum or sweat), the laboratory must provide a protocol to ensure that the specimens are not adulterated prior to the initial screening tests and does not test an adulterated specimen).
   5. Use an immunoassay procedure for the initial screening tests for all specimens, using immunoassay technology which meets, as minimum standards, the most current requirements as referenced in Mandatory Guidelines for  Federal Workplace Drug Testing Programs (80 FR 28101- Mandatory Guidelines for Federal Workplace Drug Testing Programs.  Office of the Federal Register, National Archives and Records Administration), and the following cutoffs:
      1. Amphetamines/Methamphetamine - 500 ng/ml
      2. Barbiturates - 200 ng/ml
      3. Benzodiazepines - 200 ng/ml
      4. Benzoyl ecgonine (cocaine metabolite) - 150 ng/ml
      5. Marijuana metabolite - 50 ng/ml
      6. Opiates - 2000 ng/ml
      7. Phencyclidines - 25 ng/ml
      8. Methadone - 300 ng/ml
      9. 6 Monoacetylmorphine - 10 ng/ml
   6. Use GC/MS (Gas Chromatography/Mass Spectrometry) testing for all confirmation tests using the following cutoffs:
      1. Amphetamines/Methamphetamine - 250 ng/ml
      2. Barbiturates - 200 ng/ml
      3. Benzodiazepines - 200 ng/ml
      4. Benzoyl ecgonine (cocaine metabolite) - 150 ng/ml
      5. Marijuana metabolite - 15 ng/ml
      6. Opiates - 2000 ng/ml
      7. Phencyclidines - 25 ng/ml
      8. Methadone - 300 ng/ml
      9. 6 Monoacetylmorphine - 10 ng/ml
   7. Ensure that all specimens submitted for initial screening and/or confirmation testing are tested within two working days of receipt of the specimens. The organization shall be informed by the laboratory of all positive test result(s) from any screening or confirmatory tests within 48 hours of testing via computer or fax. A hard copy of the COC must follow within 10 working days and the confirmation tests must bear the signature of the certifying scientist.
   8. Maintain all records/documents for all specimen tests for a minimum of three years and maintain records/documents for any specimen under legal challenge until the challenge is resolved. It shall be the organization's responsibility to notify the laboratory of which specimens are under legal challenge. Each organization must contract with the laboratory for forensic testimony for any legal challenge to a test result.
   9. The organization must have an annually renewed business associate agreement on file which addresses all HIPAA and 42 CFR confidentiality requirements.
   10. The organization must maintain a business associate agreement with the laboratory services entity that assures the adherence to any requirements within these requirements, including maintaining a copy of the entities valid CLIA certification for the laboratory utilized.
5. Treatment organizations may, with IDHS/DBHR approval, access the provision of necessary toxicology services from the IDHS/DBHR designated OUD toxicology vendor.

SECTION 7:  Service Requirements for Gambling Disorder Services

Target Population: Individuals and family members who need services to address a gambling disorder.

These requirements set forth the terms and conditions applicable to gambling disorder treatment and related services funded by the IDHS/DBHR. Services include gambling disorder screening, assessment, treatment, case management, community intervention and recovery support as specified herein.

Administrative Rule

All services are to be provided according to the applicable standards in Administrative Rule Title 77: Public Health Chapter X: Department of Human Services Subchapter D: Licensure Part 2060 Substance Use Disorder Treatment and Intervention Services.

Service Requirements

All treatment organizations providing any IDHS/DBHR licensed and funded level of care must meet every requirement specified in Section A. Additionally, organizations with qualified staff must meet every requirement in Sections A-B. Organizations with dedicated funding for gambling disorder services must meet requirements in Section A, B and C.

1. All SUD Treatment Organizations Funded by IDHS/DBHR
   1. Providers shall ensure that all applicable staff participate in IDHS/DBHR sponsored training, regarding administration of the gambling disorder screens and ASAM Gambling assessment prior to utilization of the tools.
   2. Each funded treatment organization shall administer the EDGE-SBIRT. The EDGE-SBIRT screening can be billed to Medicaid as part of the ASAM assessment and results in an identification of a gambling diagnosis. Other screens may be approved in writing by the Administrator of Gambling Initiative Programs. It is only mandatory to administer a gambling disorder screen once to a patient. If there is a subsequent treatment episode, the screen does not need to be administered again unless the patient screened positive as a result of the first screen or reports a significant change related to gambling behavior.
   3. If the patient screens positive for a gambling use disorder, the subsequent ASAM assessment must incorporate the ASAM guidelines for gambling disorder assessment, diagnosis, and placement. Diagnosis must follow the DSM-5 criteria and methodology for a gambling related disorder.  The National Opinion Research Center's DSM Screen for Gambling Problems (NODS), or the GA 20 (Gambler's Anonymous) can be used during the ASAM assessment for additional information to support the assessment.
   4. Each organization, especially those without a dedicated gambling program, shall provide referral information for gambling disorder treatment to any patient whose ASAM assessment indicates a need for gambling disorder treatment. At a minimum, this must include the number for the Gambling Disorder Helpline (1-800-GAMBLER), the Are You Really Winning website, gambling disorder treatment information and identification of any self-help groups or other recovery support services. A roster of gambling disorder treatment organizations is available through the helpline or website. A firm referral shall be made for such services and documentation of this referral must be present in the patient's record. The firm referral shall include specifications for information sharing regarding the gambling disorder screen and ASAM assessment so that duplicative services are not necessary.
   5. Gambling disorder treatment is not a Medicaid covered service and should be billed to IDHS/DBHR funding using the DARTS software and tagged in DARTS with an "L" tag using established standardized or provider specific rates. Consequently, the gambling disorder screen is not a Medicaid covered service and shall be billed to IDHS/DBHR funding using the DARTS software. The screen should be billed at the assessment rate in a 15-minute increment and tagged in DARTS with an "L" tag.
   6. Agencies that do not deliver gambling treatment will have referral procedures in place to ensure that patients who need gambling treatment and intervention are referred for any needed services. are made
2. All SUD Treatment Organizations Funded by IDHS/DBHR that also have qualified staff (staff that have received the 30-hour training or are certified as noted below).
   1. The organization shall have at least one staff who will deliver gambling disorder treatment services that meets the professional staff requirements specified in Part 2060.309 and has:
      1. Certification from the International Gambling Counselor Certification Board (IGCCB) as a Nationally Certified Gambling Counselor or;
      2. Certification from the Illinois Certification Board (ICB) as a Problem Counselor's Gambling Certification (PCGC) or;
      3.  Participated in the IDHS/DBHR 30-hour Gambling Disorder Training for Counselors.
   2. The organization shall document the credentials for each staff who will deliver gambling disorder treatment services on the IDHS/DBHR Gambling Disorder Professional Staff Form. This form shall be submitted to IDHS/DBHR as indicated on the form and maintained in the organization's personnel file for that staff.
   3. All gambling disorder treatment services shall be billed as specified in Section A (#5-7) and must be delivered and integrated in accordance with the requirements for SUD treatment contained in Subpart D of Part 2060. Such services are generally delivered in outpatient settings but may be provided to a patient in Level 3.1 and 3.5 residential SUD treatment if deemed medically necessary. When this occurs, the gambling disorder treatment must be delivered in accordance with ASAM guidelines and can be part of the clinical hour requirements for these Level 3 SUD treatment services as required by 77 Ill. Admin. Code 2060.410 and outlined within the treatment plan.
   4. Gambling disorder treatment shall be offered in varying degrees of intensity based on the level of care in which the patient is placed, identified medical necessity and the subsequent treatment plan developed for that patient. The treatment plan must include goals and objectives for financial recovery. If the gambling disorder treatment is delivered via telehealth, a referral agreement shall include specifications for information sharing regarding patient demographics, the gambling disorder screen and the ASAM assessment so that duplicative services are not necessary. Any services delivered via telehealth must also adhere to the provisions specified in the most current IDHS/DBHR Contractual Policy Manual.
3. All Organizations That Deliver Gambling Disorder Treatment and/or Outreach Services with Additional Dedicated Funding (specific grant for gambling treatment and/or outreach services with IDHS/DBHR)
   1. Organizations with gambling disorder dedicated funding can deliver screens, assessments, treatment, case management, community intervention and recovery support services. Services shall be billed using the "L" tag as specified in Section A (#5-7).
   2. The organization will ensure that professional staff who deliver gambling disorder services participate in monthly clinical supervision sessions, learning collaboratives, cross-training events and other related meetings arranged or convened by IDHS/DBHR to share strategies and tools related to delivery of gambling disorder services.
   3. The organization shall develop an outreach plan that will identify community intervention activities (billed using the "L" tag as specified in Section A (#5-7)) and strategies to identify, recruit and retain patients who need gambling disorder services. The outreach plan shall include planned activities for Problem Gambling Awareness Month and marketing activities that the organization will carry out during the state fiscal year (i.e., social media, signage, billboards, radio/tv advertisements, etc.) and a related budget.
   4. The organization must have linkage to and/or the capacity to create recovery services that focus on connecting the patient to skill building activities that assist in maintaining a lifestyle free of gambling and/or with self-exclusion awareness sites, self-help groups like Gam Anon or Gambling Anonymous and other financial recovery groups.
   5. Additional requirements are available via the grant agreement/contract deliverables and gambling program policies and guidelines.

SECTION 8:  Service Requirements for Substance Use Disorder Treatment Organizations That Provide Daytime Childcare and Child Domiciliary Services

Target Population: Child(ren) under age 13 that are accompanying a pregnant parent or woman with dependent children served by funded organizations as active patients in residential treatment and recovery home services.

Introduction: These requirements set forth the terms and conditions applicable to Child Domiciliary services for children whose pregnant parent or woman with dependent children are receiving substance use disorder treatment and recovery home services funded by the IDHS/DBHR. Providers receiving Child Domiciliary funding are part of the Pregnant Women and Women with Dependent Children programs and services must be in accordance with the Service Requirements found in Section 9: Service Requirements for Pregnant Women and Women with Dependent Children (PWWDC).

Administrative Rules/Guidelines

All staff providing services to the children must satisfy requirements outlined in 77 Ill. Admin. Code 2060, Parts .309(d), .311(a), and .313(d, f).  Results of the CANTS check must be in the employee's personnel file prior to working with children.

1. Child Domiciliary Core Components
   • The organization shall have the following administrative procedures and policies in place which address the following for all funded child domiciliary services:
     1. Written policy and procedures for handling medical emergencies of children residing with their parent or guardian in a residential setting.
     2. Authorization in writing from the mother or guardian that is included in the child's record for the child to be enrolled in school on-site or off-site (site is defined as the licensed treatment location).
     3. Working policies and procedures regarding the administration of medication to children.
     4. Utilization of age-appropriate safety restraints for transportation of mothers and their children and maintenance of a log documenting all transportation services.
     5. Written policy and procedures to ensure adequate oversight and assurance that all transportation vehicle operators have valid driver's licenses and insurance coverage.
     6. Appropriate and nutritional meals for children.
     7. Documentation that each child in residence has his or her own bed.
     8. Documentation of the age range of children that may be admitted to the childcare program as part of the admission criteria.

Children shall be in school or attending childcare programs either on or off-site. If the childcare program is off-site, it must be licensed by the Department of Children and Family Services (DCFS). If the organization chooses to have on-site childcare, they shall be responsible for planning and conducting developmental and age-appropriate activities for the children in their care and must adhere to requirements regarding parental presence and/or all DCFS childcare requirements.

2. Services Documentation

SECTION 9:  Service Requirements for Pregnant Women and Women with Dependent Children (PWWDC) Designated Programs

Target Population: Pregnant Women and Women with Dependent Children.

Introduction: These requirements set forth the terms and conditions applicable to substance use disorder treatment intervention and recovery support and related services funded by the IDHS/DBHR for Designated PWWDC Sites.

Definition: A PWWDC Designated Program is one that has been attested to meet the requirements outlined in the Substance Use Prevention Treatment and Recovery Block Grant (SUPTR BG) regulations for meeting the Women's Maintenance of Effort (MOE) by the Division; reports all services via DARTS or other approved Division mechanisms; and adheres to all specialized service and monitoring requirements.

PWWDC Administrative Requirements

1. Federal Requirements
   • All sites must follow the Substance Use Prevention, Treatment, and Recovery Services Block Grant Regulations, 45 CFR, Parts 96.124 and 96.131, Requirements Regarding Pregnant Women and Women with Dependent Children.
2. Monitoring Requirements Specific to PWWCD Designated Program
   1. PWWDC sites will be monitored to determine compliance with the requirements specified herein. Any non-compliance determined because of monitoring will be shared with organization and corrective action plans shall be submitted as requested by the Division. The organization shall comply with all corrective action. Technical assistance may be provided.
   2. All PWWDC sites shall complete the narrative section of the Annual On-Line Certification Plan Survey (ACP) describing how the organization, in practice, ensures that all staff understand the federal requirements specified herein and how daily practice ensures such compliance.
   3. A desk review will be conducted annually that will, at a minimum, review organization policies and procedures.
   4. PWWDC programs will be selected on a rotating basis for a review of clinical records by an independent peer reviewer.
   5. Annual random consumer satisfaction surveys will be conducted.
3. Reporting Requirements
   1. All PWWC services must be reported to DARTS to ensure payment and continued status as a designated site.
4. Program Requirements

   PWWDC programs will treat the family as a unit and therefore will admit both women and their children into treatment services, if appropriate. All PWWDC programs must either provide or arrange for ALL the following services to meet the SUPTR MOE regulations:

   • Primary medical care, including prenatal care
   • Primary pediatric care for the women's children, including immunizations
   • Gender-specific substance use disorder treatment
   • Other therapeutic interventions for women addressing issues such as relationships, sexual and physical abuse, and parenting
   • Therapeutic interventions for children in custody of women in treatment to address, among other things, developmental needs, sexual abuse, physical abuse, and neglect of the children.
   • Childcare while the women are receiving service.
   • Sufficient case management and transportation to ensure that the women and their children have access to the above service. Confirmation of the direct delivery of services or through referral shall be documented in record.
5. Other PWWDC Program Requirements
   1. Sites shall have supervisors and staff who hold or are in the process of obtaining the Gender Competency Endorsement credential from the Illinois Certification Board (ICB). 
   2. Each PWWDC site shall have an identified representative on any committee established by the Illinois Advisory Council on Substance Use Disorders that is charged with planning a statewide system of care for women and their dependents.
   3. PWWDC sites are recommended to utilize the Guidance to States: Treatment Standards for Women with Substance Use Disorders to evaluate current practices and identify elements that need to be improved and successes to replicate to provide optimal services.
   4. Staffing within a PWWDC Designated Program should be specialized. Supervisors and most staff working within these programs should hold or be working towards obtaining the Illinois Certification Board's Gender Competency Endorsement (GCE) along with their credentials. The mission of the GCE is to be committed to the provision and improvement of effective, gender-specific specialized treatment services for women in Illinois. Professionals with GCE combine a distinct knowledge base with human service skills to deal with the unique attitudes and behaviors associated with the support for treatment of substance use disorders in women. Knowledge and skill bases may be acquired through a combination of specialized training, education, and supervised work experiences¹. (¹ The Illinois Model for the Gender Competency Endorsement, ICB.)
   5. Policies and procedures need to ensure all new staff have the competencies to serve the targeted population. The Division recommends SAMHSA's Women, Children and Families Technical Assistance online training for new staff: Introduction to Women and Substance Use Disorders, which is a 12-hour, self-paced course that helps counselors and other practitioners working with women to better understand women's substance use, treatment and recovery experiences and effective interventions for women.
   6. A Program Self-Assessment such as the Gender-Responsive Program Assessment tool can be utilized to assist in determining if a site is providing optimal services to pregnant women and women with dependent children. The Division recommends the Gender-Responsive Program Assessment tool which was developed for program administrators, evaluators, agency monitors and staff to use to evaluate the gender responsiveness of programs for women and girls. The assessment instrument is based on the fundamental elements of quality programming including the guiding principles from the Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders Report (Bloom, Owen, & Covington, 2003).
6. Resources

SECTION 10:  Service Requirements for Bureau of Prevention Services Funded Organizations

General Substance Use Prevention Program Requirements

1. All Substance Use Prevention Program (SUPP) grantees must have at least 1 Full-Time Prevention Specialist per SUPP grant agreement. Grantees must have one Full Time Equivalent (FTE) for every $90,000 in SUPTRS Block Grant funding from IDHS/DBHR. All Prevention Specialists (fulltime or parttime) must meet IDHS/DBHR Prevention training requirements within one year of hire.
2. Blended funding (federal and state) requires grantees to comply with all block grant requirements found in this manual.
3. A grant contact staff must be assigned by grantee as the primary programmatic communications contact.
4. All staff budgeted to provide services as well as the grantee authorized representative, primary fiscal contact, and primary program contact must be entered and updated as necessary on the Prevention Hub. The Prevention Hub is the reporting system for prevention activities associated with the Substance Use Prevention Program.

Substance Use Prevention Program (SUPP) Services (CSUPS, SUPS) are delivered by community-based organizations that provide prevention services as delineated by grant agreement deliverables. The grant supports universal and selected services serving youth in 6th-12th, their parents, and the community-at-large. Grantees must serve target populations through an array of prevention services including youth prevention education, communication campaigns, information dissemination including local Illinois Youth Survey (IYS) results, IYS participation by local schools, National Prevention Week activities, youth advisory committee membership, National Prescription Drug Take-Back Days activities, and collect/disseminate information about resources.

State and Regional Substance Use Prevention Services (SRSUPS) are part of the SUPP and are delivered by non-profit organizations that have a broader reach. Prevention services are delineated by grant agreement deliverables and are either delivered in specified regions or statewide. Grantees must choose a target population that defines the deliverables to be met. Deliverables include (depending on the target population) youth prevention education, youth leadership, college substance use prevention services, and prescriber training.

The Tobacco Enforcement Program (TEP) is part of the Bureau of Prevention Services' Tobacco Prevention Programs. Local municipalities and counties work with law enforcement to implement the program. The program supports Illinois's efforts to curb the sale of tobacco products to underage individuals as specified under Tobacco 21 and local ordinances. Grantees are to conduct compliance checks by contracting with individuals under 21 years of age who will attempt to purchase tobacco products through supervised visits at tobacco retailers where individuals under 21 years of age can legally enter. Tobacco retailers included in the unannounced compliance checks are to be provided with information on what constitutes illegal sales to individuals under 21 years of age provided by the state.

Prevention services funded through discretionary grants must adhere to the particular grants' requirements.

SECTION 11:  Service Requirements for Stabilization and Transition Services (ST)

Target Population: Adults 18 years and older who need short term ST services.

Administrative Rules/Guidelines:

Stabilization and Transition services are not authorized under Administrative Rule 2060. However, an organization providing this service must be licensed as a 3.7 or 3.5 under Administrative Rule: Title 77: Public Health Chapter X: Department of Human Services Subchapter D: Licensure Part 2060 Substance Use Disorder Treatment and Intervention Services.

Stabilization and Transition Specific Programmatic/Service Requirements:

Specific Reporting Requirements

SECTION 12: Requirements for Peer Recovery Support (PRS) Services

Target Population: Adults 18 years and older in need recovery support services.

Introduction: These requirements outline the terms and conditions for Peer Recovery Support Services for both adults and adolescents throughout the continuum of care. This means that PRS can be offered during community intervention efforts pretreatment, while individuals are in treatment, and after they have been discharged from treatment.

Clinical Services versus PRS Services

Both clinical and PRS services are essential for individuals dealing with complex substance use and/or mental health conditions. Although these services differ, they share a foundational principle of unconditional positive regard for the individual and a mutual desire to create a connection. This shared understanding helps individuals feel acknowledged, which enhances the effectiveness of the services.

Clinical services are provided during enrollment in or admission into a treatment setting licensed for substance use disorder services and are delivered by professional staff, as defined in 77 Ill. Admin. Code 2060. These services include, but are not limited to, assessment, individual or group counseling, treatment planning, ongoing service reviews, and recovery/discharge planning. The organization may also determine that certain specified activities require the involvement of professional clinical staff.

Previously referenced as Recovery Support Services (RSS), PRS services are delivered by individuals who are trained and certified to use their personal experiences in recovery. PRS professionals assist individuals at any stage of their recovery journey by offering support rooted in shared understanding, respect, and mutual empowerment, which helps each person feel valued and respected.

PRS and Medicaid Coverage

The Department of Health and Family Services announced coverage of Peer Recovery Support (PRS) Services in accordance with Public Act 102-1037. Please review the Provider Notice to understand and implement the Coverage of PRS per Public Act 102-1037.

These services will be covered in both the Illinois Medicaid fee-for-service (FFS) program and HealthChoice Illinois (HCI) managed care organizations (MCOs) for HFS-enrolled customers, when delivered by a provider licensed by IDHS/DBHR.

Service Requirements:

PRS Delivered to Patients in Treatment

1. Service Definition: PRS services are nonclinical in nature, culturally responsive, and supportive of a patient's treatment goals throughout all stages of the treatment and recovery process. PRS services are delivered person to person. PRS groups cannot be billed to the IDHS/DBHR grant. PRS is aimed at increasing recovery capital by empowering individuals through strength-based coaching, supporting linkages to community resources and the development of natural supports, supporting engagement in treatment services, and educating customers and their families about the conditions and process of recovery. Services can include contact with family members or other collaterals if the purpose of the collateral's participation is to focus on the needs of the patient by supporting the achievement of the patient's recovery or treatment goals. PRS services may be delivered in-person or via telehealth (audio and/or video).
2. Medical Necessity: PRS services are considered medically necessary when they are recommended by a physician for a patient with a diagnosed substance use disorder (SUD) or co-occurring substance use and mental health condition, including gambling disorder, as listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), that has a documented impact on the customer's functioning in one or more life domain(s). Medical necessity for PRS services must be documented on the patient's recovery or treatment plan and signed by the authorizing physician.
3. Staff Qualifications: PRS is a separate service from substance use disorder treatment; PRS services and treatment services 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 in the same program. PRS services are provided directly by a peer support worker, operating under the supervision of a qualified "professional staff" as defined in 77 Ill. Admin. Code 2060, and who meet all the following qualifications:
   1. Are at least 18 years of age.
   2. Have a minimum one year of recovery from substance use, mental health, or co-occurring substance use and mental health challenges. Certified by the Illinois Certification Board (ICB, Inc.) as a Certified Recovery Support Specialist (CRSS) or as a Certified Peer Recovery Specialist (CPRS) or be certified within one year of employment date.
   3. Demonstrates the ability to work within agency structure, accept supervision, and participate as a member of a multi-disciplinary team, when applicable
4. Documentation: PRS should first be documented in the ASAM assessment as an assessed need. Secondly, the development of the treatment plan should include at least one goal and objective relative to the PRS need. For example, a goal might specify the initiation to PRS, and the objective could be to facilitate an introduction to a Peer Support staff. If PRS is subsequently implemented, a Recovery Plan would then be developed with the Peer Support staff. This Recovery Plan should document all PRS activities and must be signed by the staff delivering the service. Progress notes for PRS activities should indicate time/date and duration. PRS must also be delivered in accordance with all other service specifications contained within the current Contractual Policy Manual (CPM).
5. Payer of last resort: If the individual is in treatment with another organization or has Medicaid or third-party insurance, you cannot bill the SUPR grant for PRS. All third-party payment benefits, including Medicaid or other state or federal funds, must be identified and accessed first before using grant funds.
6. Reporting Requirements: For Medicaid and the DBHR grants, all demographic fields must be completed, including a Recipient Identification Number (RIN) and billed under the community intervention unit/program/site with an activity code of 21 (for staff time).

PRS for Individuals Not Enrolled in Treatment

1. Service Definition: PRS outside of treatment is delivered to individuals in the community in need of PRS to support their recovery efforts and billed only to the IDHS/DBHR grant. PRS services may be delivered in-person or via telehealth (audio and/or video). PRS groups cannot be billed to the IDHS/DBHR grant.
2. Staff Qualifications: PRS services are provided directly by a peer support worker and who meet all the following qualifications:
   1. Are at least 18 years of age.
   2. Be Certified as a Certified Recovery Support Specialist (CRSS) or as a Certified Peer Recovery Specialist (CPRS) or be certified within one year of employment date. 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 PRS must be a person with lived experience, and agree to follow ICB Code Of Ethics For Certified Recovery Support Specialist (pdf) and Certified Peer Recovery Specialist (pdf). Organizations are responsible for maintaining proof of the ICB Code of Ethics attestation for each PRS staff with their own lived experience when they do not meet the minimum qualifications upon hire. Organizations must provide supervision to any PRS staff that do not meet the minimum qualifications upon hire.
   3. Documentation: PRS services must be documented in a recovery plan and the plan must address the four major dimensions of recovery identified by the Substance Abuse and Mental Health Service Administration https://www.samhsa.gov/substance-use/recovery/about PRS services must be signed by the staff delivering the service and indicate the activity, time/date and duration. Organizations must establish and maintain audit trails to demonstrate compliance and avoiding financial penalties.
3. Payer of last resort: If the individual is in treatment with another organization and has Medicaid or third-party insurance, the organization cannot bill the IDHS/DBHR grant for PRS. All third-party payment benefits, including Medicaid or other state or federal funds, must be identified and accessed first before using grant funds.
4. Reporting Requirements: PRS services are billed under the community intervention unit/program/site with an activity code of 21 (for staff time).