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Provider Notice Issued 12/28/2016

Fee-For-Service Reimbursement for Licensed Clinical Psychologist (LCP) or a Licensed Clinical Social Worker (LCSW)

​To:

​Enrolled Medical Assistance Providers

​Date:

​December 28, 2016

​Re:

Fee-For-Service Reimbursement for Licensed Clinical Psychologist (LCP) or a Licensed Clinical Social Worker (LCSW)

This notice informs providers that the Department of Healthcare and Family Services (HFS) will begin fee-for-service (FFS) reimbursement for certain services provided by Licensed Clinical Psychologists (LCPs) and Licensed Clinical Social Workers (LCSWs) enrolled for participation in the Department’s Medical Programs beginning with dates of service on or after January 1, 2017. Enrolled providers are not required to make changes in IMPACT in order to bill the Department FFS. 

Fee-for-service reimbursement is eligible for services billed and rendered by an LCP or LCSW. This change applies to services rendered by individual LCPs and LCSWs practicing outside a Community Mental Health Center, Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) setting. Reimbursement is not eligible for services identified in 89 Ill. Adm. Code 140.6, self-administered and self-scored tests of cognitive function or biofeedback therapy. 

Billing instructions and the LCP/LCSW fee schedule will be published in January 2017. 

Licensed Clinical Psychologist Services

The Department will reimburse LCPs for psychological and neuropsychological testing including diagnostic evaluation and therapeutic services provided in the office, home or community setting for individual psychotherapy and family or group psychotherapy for which the purpose is the treatment of the patient. Group psychotherapy services must meet guidelines set forth in 89 Ill. Adm. Code 140.462 (c)(2) and (d)(2). 

LCPs who hold a current prescribing psychologist license or have and maintain a current written collaborative agreement with a collaborating physician as defined in the Clinical Psychologist Licensing Act (225 ILCS 15/) may prescribe medications. All prescriptions must meet the requirements set forth in 89 Ill. Adm. Code 140.414 

The collaborating physician is not required to be enrolled with the Department, however, may not be terminated, suspended or barred by the Department from participating in the Medical Assistance Program. The LCP must notify the Department within 10 business days if an agreement is dissolved or if a change occurs in the collaborating agreement. Collaborative agreements must be updated and maintained on file at each practice location, and be available to the Department upon request. 

Licensed Clinical Social Worker Services 

The Department will reimburse LCSWs for diagnostic evaluation and therapeutic services provided in the office, home or community setting for individual psychotherapy and family or group psychotherapy for which the purpose is the treatment of the patient. Group psychotherapy services must meet the guidelines set forth in 89 Ill. Adm. Code 140.462 (c)(2) and (d)(2). 

Questions regarding this notice should be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

 

Felicia F. Norwood

Director

Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director