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Proposed Changes In Methods And Standards 

 

State of Illinois
Healthcare and Family Services

Proposed Changes In Methods And Standards For Establishing
Medical Assistance Payment Rates For Certain Services

The Illinois Department of Public Aid (DPA) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medicaid program. These changes are being made to implement the State fiscal year 2006 budget and to maintain access to necessary medical services.

Community Mental Health Services—Screening, Assessment and Support Services (SASS)

In order to ensure that necessary services are available to children and adolescents experiencing a mental health crisis, t he DPA proposes to amend the Title XIX State plan and its administrative rules to provide a payment to certain community mental health providers that have entered into an agreement with the DPA, the Department of Human Services, and the Department of Children and Family Services to provide SASS. These service accessibility assurance payments will be made in two installments, paid during the months of June and August 2005.

The payment methodology takes into account (1) the proportion of children in poverty in Illinois that resided within the area served by the provider, as reported in the 2000 census, (2) the proportion of the land area of Illinois served by the provider, and (3) the proportion of Medicaid-enrolled children and adolescents who were enrolled in the SASS program, since July 1, 2004, that were served by the provider, as identified from clean and payable claims received by the DPA. The June payment will be based upon claims adjudicated through the end of May; the August payment will be based upon claims adjudicated through the end of July.

This payment methodology is effective June 1, 2005, and will cease on August 30, 2005. This change will result in an increase in expenditures of $2.75 million—half during each of fiscal years 2005 and 2006.

Time, place and manner in which interested persons may comment on the proposed rate and methodological changes

Any interested party may submit comments, data, views, or arguments concerning these proposed changes in reimbursement methods and standards. All comments must be in writing and should be addressed to:

Bureau of Program and Reimbursement Analysis
Division of Medical Programs
Illinois Department of Public Aid
201 South Grand Avenue East
Springfield, Illinois 62763-0001

E-mail address: bpra@idpa.state.il.us

Interested persons may review these proposed changes on the Internet at: HFS Public Notices. Local access to the Internet is available through any local public library. In addition, this material may be viewed at the DHS local offices (except in Cook County). In Cook County, the changes may be reviewed at the Office of the Director, Illinois Department of Public Aid, 100 West Randolph Street, Chicago, Illinois. The changes may be reviewed at all offices Monday through Friday from 8:30 a.m. until 5 p.m. This notice is being provided in accordance with federal requirements found at 42 CFR 447.205.