Community Mental Health Center Updates

October 18, 2016

Memorandum

Last week, the Illinois Department of Healthcare and Family Services (HFS) released three notices related to Community Mental Health Centers (CMHCs) containing the following changes:

  • Reissuing the Community Mental Health Services: Service Definition and Reimbursement Guide (SDRG) with substantive modifications; and
  • Two notices relating to time-limited, enhanced payment for psychiatric services provided within CMHCs, including an updated fee schedule and instructions to
    resolve impacted claims already submitted.

Updates to the Community Mental Health Services Guide
On Oct. 12, 2016, HFS issued a Provider Notice on reissuing the Community Mental Health Services: Service Definition and Reimbursement Guide. The primary modifications made to the guide include:

  • Substantive format change, transitioning into two parts—separating coding from fee schedule;
  • Time-limited rate add-on for Fiscal Year (FY) 2017, noted below with hyperlinks to the HFS notices;
  • Coding updates, including changes to the Individual Care Grant and Psychotropic Medication Monitoring; and
  • Legacy services that should have been removed previously and were funded by the Department of Human Services’ Division of Mental Health were removed in this version, including subsidies for utilities and housing.

Any questions regarding this update may be directed to the Department at: HFS.CBH@illinois.gov, using the subject line “SDRG,” or by calling 217-557-1000.

Enhanced Payment for Psychiatric Services Provided Within CMHCs
On Oct.13, 2016, two Provider Notices detailing time-limited psychiatric service payment add-ons were issued. The notices provide direction on payment changes for targeted services provided within a CMHC between July 1, 2016 and June 30, 2017 and new procedures that may be necessary to receive the enhanced payment.

Psychiatric Services Provided Within CMHCs
This notice applies to physicians who work in a CMHC and bill HFS directly as a physician while having designated a CMHC as their Payee.

  • Any qualifying FY 2017 services previously adjudicated must be voided and rebilled consistent with the notice, which requires inclusion of the UB modifier and CMHC payee. The updated Practitioner Fee Schedule includes a tab with the enhanced payment to providers for fee-for-service psychiatric services provided between July 1, 2016 and June 30, 2017.

Enhanced Payment for Psychiatric Services Provided Within CMHCs
This notice applies to physicians, advanced practice nurses or any community mental health provider who provides a qualifying service as detailed in the Service Definition and Reimbursement Guide and bills HFS as a CMHC.

  • HFS will automatically adjust qualifying FY 2017 claims that have been adjudicated on behalf of providers. Services qualifying for the enhanced payment are identified in the Community Mental Health Services Fee Schedule.

Specific questions about obtaining rate enhancements should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.