Specialty Telehealth and Assessment Team (STAT) Services
Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.25.XX
Purpose:
Pursuant to Public Act 0593-103, individuals living in 24-hour Community Integrated Living Arrangements (CILA) and Host Family CILAs now have access to Specialty Telehealth and Assessment Team (STAT) services. The STAT service provides a remote telehealth assessment when the individual's primary care physician is unavailable, designed to coordinate individual's care with local emergency departments, urgent care facilities, primary care physicians, and other healthcare providers to enable real time medical support, consultation, and coordination on physical health issues. The STAT service assists individuals and providers to understand presenting health symptoms and to identify the most appropriate next steps. The STAT service has the billing code 52T.
Description of STAT Visit and Responsibility of CILA Providers:
The STAT service is consultative in nature and provides disability-specific guidance on when best to seek additional or in-person medical treatment for the individual. It is not meant to be an alternative to having a primary care physician. This is a supportive service that typically occurs while the individual is in their home (24-Hour or Host Family CILA) to help assess their need for medical attention. STAT services are required to be delivered in a private setting with only the individual receiving services and staff required to provide any support.
Support needs during the STAT visit are evaluated and provided based on the individual's requests, preferences, and needs, especially any privacy and HIPAA concerns. The CILA provider is responsible for providing support to an individual during the STAT visit to ensure that they are able use the technology required for the service. The STAT visit must occur in a private space which may be the individual's bedroom or bathroom. STAT services are not conducted while an individual is using the bathroom, showering, or doing anything else that should be done in private. In-person visits are not required but may be recommended by the provider following the telehealth service.
The STAT service also provides consultation to paid caregivers during the STAT appointment.
Availability and Qualifications of STAT Clinicians
The STAT service is available 24-hours a day, 7-days a week and includes immediate evaluations, video-assisted examinations, development of treatment plans, and discussion and coordination with individuals and/or paid caregivers. During the STAT visit, the individual will receive medical support from a Physician's Assistant, an Advanced Nurse Practitioner, a Registered Nurse, or a Board-Certified Physician. All clinicians must have clinical expertise working with individuals with intellectual or developmental disabilities. If a hospital visit is clinically necessary, this service allows the STAT provider to communicate with the emergency department directly, ensuring advance preparation for the emergency department and potentially decreasing the need for inpatient admission.
This service must be provided or overseen by physicians who are:
- Licensed to practice medicine in Illinois, or have appropriate reciprocity; and
- Board Certified or board eligible with the American Board of Medical Specialties (ABMS).
Functions which are overseen by a physician with the above qualifications will be provided by a Registered Nurse, Certified Registered Nurse Practitioner, or Physician's Assistant acting within their scope of practice.
In order to be approved by IDHS-DDD, a potential STAT provider must be successfully enrolled in IMPACT and have the following experience including but not limited to:
- Have a minimum of five years' experience in serving individuals with intellectual and developmental disabilities in their own homes, family homes, licensed residential homes, Intermediate Care Facilities (ICFs), or other types of long-term supports and services.
- Have demonstrated evidence of positive outcomes for patients which includes at a minimum; reductions in Emergency Room visits and inpatient stays; and caregiver and individual satisfaction with the service.
- Have a comprehensive quality review program and provide a report via secure e-mail of aggregated findings quarterly, as well as one time annually, to the Division of Developmental Disabilities
- All staff who provide this service must have completed specialized training/curriculum on how to provide medical assessment, treatment interventions, and recommendations regarding the physical health care needs of individuals with intellectual disabilities and/or developmental disabilities.
- Physicians providing this service must have access to and be familiar with clinical guidelines for the provision of health care to individuals with intellectual and developmental disabilities. Clinical guidelines must be based on evidence-based practices and clinical expertise and serve to inform the health care decisions and recommendations.
Process for Obtaining the STAT Service for Individuals:
- For individuals new to Adult DD waiver CILA services, when their application for 60D CILA Support Services packet is submitted, the Independent Service Coordination Agency (ISC) will indicate that they want the STAT service (52T).
- The ISC will also add this service in the Summary of Services section of the Personal Plan, which does not require additional individual or guardian signatures and does not require a new provider signature page.
- For individuals already receiving CILA waiver services who decide to add this service, the ISC will submit a turnaround form including the STAT (52T) billing code. ISCs will again add this service to the Summary of Services section of the Personal Plan, which does not require additional individual or guardian signatures and does not require a new provider signature page.
- During the annual Person-Centered Planning process, the ISC should discuss the STAT service. If the individual chooses to have this service, the ISC should identify this in the Personal Plan and follow the above steps to allow it to be billed.
- DDD will notify the STAT provider to contact the individual and the CILA provider will work with the STAT provider to address any set up requirements so that the service can be provided consistent with HIPAA and privacy guidelines.
- The STAT provider will submit billing monthly through ROCs using the 52T code.
- Annually, the ISC will review this service through the person-centered planning process to ensure the individual wants to continue the services.
NOTE:
The STAT service is only provided when it is requested by the individual and included in their Person Plan. The telehealth delivery of this the service meets HIPAA requirements. The CILA provider cannot require an individual living in a home to enroll in this service.
Becoming a STAT Provider
To be a provider of this services, organizations must enroll in IMPACT and submit an application containing proof of required credentials to the IDHS-DDD clinical team for approval. Once the provider is approved in IMPACT and by the IDHS-DDD clinical team, the STAT provider will use the bill code 52T and will be able to the bill monthly at a rate per month per person.
Contact:
Please email comments on this DRAFT Information Bulletin to DHS.DDDComments@illinois.gov. Please include the title of the DRAFT IB in the subject line of the email.
Effective Date:
May 1, 2025
