Utilization Management Program - FY17

Dear Community Providers:

DHS/DMH has made changes to the Utilization Management Program for FY17. Effective July 1, 2016, only team services will require authorization through the Illinois Mental Health Collaborative for Access and Choice. Services no longer requiring external authorization through the Collaborative include therapy/counseling, psychosocial rehabilitation, community support group, and the services in the Region 1South and Northwest Crisis Care Systems. This change is the result of a number of factors, including the large number of individuals now served through Managed Care Organizations. In addition to the transition from payer for mental health services, as the Mental Health Authority in Illinois, DHS/DMH intends to focus our resources on assisting our providers in transforming to a value-based system, where the focus is on the outcomes of care for the individuals served. Please note that at this time, all services reimbursed by DHS/DMH remain subject to medical necessity requirements as defined by Rule 132, and that any services reimbursed through an MCO will continue to be subject to any utilization management programs specific to that MCO.

Any questions related to this change in policy may be addressed to your Regional staff.

Thank you.