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Julie Hamos, Director
Department of Healthcare and Family Services

The Save Medicaid Access and Resources Together (SMART) Act (P.A. 97-689) made two changes in the Illinois Medicaid Program for our clients with substance use disorders who are admitted to hospitals for in-patient detoxification services. 

First, the new law placed limitations and required concurrent review for every hospital detoxification stay within 60 days of a previous detoxification stay. Second, it required the Department of Healthcare and Family Services (HFS), along with our sister agency, the Division of Alcoholism and Substance Abuse (DASA) of the Department of Human Services (DHS), to “convene a workgroup to develop recommendations for quality standards, diversion to other settings, and admission criteria for patients who need in-patient detoxification." Pursuant to P.A. 98-104 and stakeholder involvement, these recommendations are being published.

We understood from the outset that restrictions on hospital admissions and readmissions would not alone achieve the State’s goal: to facilitate access to medically appropriate detoxification services, in the most appropriate setting, with appropriate linkages to community-based substance abuse treatment and recovery support services. That is why we are working with providers and managed care entities to build integrated delivery systems around these clients, which will offer a network of health, behavioral health and social services, with assistance from a care coordinator to help navigate the system. In the short term, we will test the effectiveness of these linkages through a demonstration program which partners hospitals and community-based providers.

This report is the product of a deliberative process that included representatives from hospitals, community-based providers, managed care entities and state agencies. We invite your feedback and comments, as we set about to implement these new policies. We are convinced that the implementation of new policies, programs and protocols with greater access to medication assisted treatment, and a cohesive and coordinated approach to care will improve health outcomes for these clients with behavioral health needs.

Thank you to Sharron Matthews, the Assistant Director of HFS, and to DASA and Mental Health Divisions Director Theodora Binion and her staff for their excellent work in convening these workgroups and keeping everyone focused and on track. We look forward to our continued work together.

Julie Hamos
Director, Illinois Department of Healthcare and Family Services