September 2016 Update

September 27, 2016

Memorandum

IHA Behavioral Health Update: Medicaid Rate Increase, SASS Eligibility Authorization, Claims Processing Issues

IHA has been tracking important developments in behavioral health issues impacting hospitals and the patients and communities they serve. They are:

  • Department of Healthcare and Family Services (HFS) proposed rate increase for community-based behavioral health services;
  • SASS eligibility authorization not affected by IES Phase 2 roll out delay; and
  • HFS claims processing issues.

Targeted HFS Rate Increase for Community-Based Behavioral Health Services

On September 26, HFS issued a public notice proposing to increase reimbursement rates for specific psychiatric and behavioral health services rendered by a physician, advanced practice nurse or a licensed community mental health center. These services include but are not limited to mental health assessment, psychological evaluations, medication management, psychotherapy and counseling.

The reimbursement changes will apply to mental health rehabilitative services provided in or by community mental health centers, as well as the physician benefit categories. These proposed changes will increase expenditures by approximately $27.5 million based on current utilization patterns. Of that increase, $25.65 million applies to the mental health rehabilitative services benefit category and $1.35 million applies to the physician benefit category. 

The proposed change is subject to approval by the Centers for Medicare & Medicaid Services and may be revised during the approval process. This proposal aligns with the Department’s goal of transitioning grant-based funding to Medicaid reimbursable services.

Authorization for SASS Eligibility Not Impacted by IES Rollout Delay

The rollout of Phase 2 of the Integrated Eligibility System (IES) planned for Sept. 26 has been delayed. Authorizations for Screening, Assessment and Support Services (SASS) eligibility segments, or HFS Social Service segments, should not be impacted during this delay.

HFS and IHA recently communicated delayed SASS eligibility segment authorizations for youth with “begin” dates of service from Sept. 20-25, due to the planned transition of the Crisis and Referral Entry Services (CARES) telephone response service to the IES on Sept. 26. 

IHA has been informed that the eligibility segment authorizations from Sept. 20-25 should be settled now, and no further SASS delays are expected until the transition to IES occurs. Questions for HFS may be directed to the Children’s Behavioral Health Unit at hfs.cbh@illinois.gov or 217-557-1000.

HFS Claims Processing Issues
HFS has also announced two system issues affecting SASS claims submitted by Community Mental Health Centers and Individual Care Grant (ICG) claims. IHA is sharing these system issues for hospitals and health systems that own or partner with community-based mental health centers. The problem has not been resolved yet, and providers are instructed to continue to monitor the HFS Claims Processing System Issues webpage for updates.

SASS Claims Processing Issues
Department of Human Services – Division of Mental Health and SASS claims submitted by Community Mental Health Centers are either paying incorrectly or rejecting with the A59 - Procedure/Modifier/POS Combination Invalid - error code. This problem is recorded to have begun in July 2016. In addition, some DHS/DMH claims submitted by Community Mental Health Centers for claims with dates of service on or after July 1, 2016 (Fiscal Year 2017) are receiving the “D04 - Suspended for Department Review” error code. This is an informational only error message and claims will continue to be processed and adjudicated once the hold edit is lifted.

ICG Claims Processing Issues
ICG claims for dates of service on or after July 1, 2015 (Fiscal Year 2016) are rejecting with the “C17/Illogical Place of Service and C33/Procedure Illogical for Role” error codes. Please note ICG claims for dates of service on or after July 1, 2016 (Fiscal Year 2017) will be rejected if billed at this time. This problem is recorded to have begun in July 2016.

Questions for HFS may be directed to hfs.webmaster@illinois.gov with the subject line “Claims Processing System Issues”.