Date: August 5, 2021
To: School Based/Linked Health Clinics; Licensed Clinical Psychologists; Licensed Clinical Social Workers; Licensed Marriage and Family Therapists; and Licensed Clinical Professional Counselors
Re: School Based/Linked Health Center Enrollment for Behavioral Health Services
This notice informs School Based/Linked Health Centers (SBHCs, Legacy Provider Type 056) of planned enrollment changes that will allow coverage of behavioral health services in this setting. This change will affect customers covered under Medicaid fee-for-service as well as HealthChoice Illinois managed care plans.
The Department is experiencing a delay attributable to an IMPACT provider enrollment issue involving enrollment of SBHCs with a Licensed Clinical Professional Counselor (LCPC) specialty. This enrollment issue will not be resolved until December. However, upon resolution, the Department will:
- Have automatically backdated enrollment of SBHCs with the following behavioral health subspecialties to October 1, 2019 (or the provider enrollment date, if later):
- Behavioral Health/Licensed Clinical Social Work Services (LCSW) (Legacy Category of Service 058)
- Behavioral Health/Licensed Clinical Psychologist Services (LCP) (Legacy Category of Service 059)
- Behavioral Health/Licensed Marriage and Family Therapist (LMFT) Services (Legacy Category of Service 088)
- Behavioral Health/Licensed Clinical Professional Counselor (LCPC) Services (Legacy Category of Service 088)
- Systematically allow time overrides on behavioral health claims submitted electronically for services rendered by the above providers retroactive to dates of service beginning October 1, 2019
Reimbursable behavioral health procedures for these providers will be identified on a separate tab of the School Based/Linked Health Center Fee Schedule. These services will be reimbursed at 75% of the physician rate. Procedure codes must be billed with the appropriate modifier for correct processing of claims:
Modifier AJ = Behavioral Health/Social Work Services
Modifier AH = Behavioral Health/Psychologist Services
Modifier HO = Behavioral Health/LMFT and LCPC Services
The Department will update SBHCs via provider notice when the enrollment issue has been resolved and SBHCs may begin to submit claims. At that time, the Department will lift timely filing edits for fee-for-service claims. Providers must follow managed care plan guidance to obtain time overrides for managed care claims.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service claims, or to the applicable HealthChoice Illinois managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs