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Provider Notice Issued 04/15/2022

Date:    April 15, 2022 

To:       All Medical Assistance Program Providers 

Re:      Coverage of Violence Prevention Community Support Team Services

_______________________________________________________________________________________________________TThis notice announces coverage of a team-based model of mental health care that addresses trauma recovery from chronic exposure to firearm violence for Medicaid eligible children and adults, consistent with the requirements of the Reimagine Public Safety Act (430 ILCS 69).  Violence Prevention Community Support Team (VP-CST) is a specialized model of the existing service of Community Support Team that delivers culturally responsive, trauma-focused mental health services and supports. VP-CST services will be covered under both Medicaid fee-for-service and Medicaid managed care organization plans effective for dates of service on or after May 1, 2022. 

HFS will be hosting an informational webinar for providers interested in delivering VP-CST services on Tuesday, April 26, 2022, from 9:00 AM – 10:30 AM. The webinar will provide additional information regarding VP-CST services and will offer an opportunity for providers to ask questions. Providers can register to attend the webinar here.

Additional information regarding service delivery, provider enrollment, and reimbursement is outlined below. Updates to the Community Based Behavioral Services (CBS) Handbook and the corresponding fee schedule to include information regarding VP-CST services are forthcoming.

Service Delivery Requirements 

The service of VP-CST is provided under the direction of a full-time Qualified Mental Health Professional (QMHP), is available to the customer 24 hours a day, 365 days a year and is intended to reduce traumatic stress symptoms and increase community functioning for individuals who have experienced chronic exposure to firearm violence. VP-CST services use evidence-informed, trauma-specific interventions and techniques to engage customers in the service delivery and trauma recovery process, develop strategies and plans to increase safety and community stabilization, and assist customers in the development of functional, interpersonal, and community coping skills. Customers served in the VP-CST program must have access to the following interventions and supports:

 

        • Proactive service engagement and peer supports delivered by a Peer Support Worker (PSW);
        • Individual, group, and family therapy/counseling utilizing evidence-informed, trauma-specific interventions and techniques (e.g., Cognitive Behavioral Therapy, Motivational Interviewing, S.E.L.F. framework); and,
        • Individual and group community support services.

VP-CST services must be provided during times and at locations that are convenient to the customer and their family, accommodates their service and treatment needs and preferences, with an emphasis on services delivered in home and community settings, including schools, as appropriate. 

 

Provider Qualifications

VP-CST services may be delivered by an enrolled Community Mental Health Center (CMHC) or Behavioral Health Clinic (BHC) that has received program approval from the Department to deliver VP-CST services. VP-CST services are delivered by a multidisciplinary team, with staffing ratios sufficient to ensure a caseload of no more than 18 customers per each full-time equivalent staff. The VP-CST team must consist of the following: 

  • A team lead that meets the qualifications of a QMHP;
  • A PSW.  For the purposes of VP-CST, a PSW is defined as an individual who: 1)  is 21 years of age or older; 2) delivers services from the peer perspective under the supervision of a QMHP; 3) has lived experience with firearm violence, either directly or through community exposure; 4) demonstrates the ability to work within the provider's structure, accepts supervision, and participates as a member of a multi-disciplinary team, when applicable; and, 5) has completed a Department approved peer support training or certification process; and,
  • Have at least one other staff member that minimally meets the credentials necessary to deliver therapy/counseling and/or community support services.

Provider Enrollment 

CMHCs or BHCs interested in delivering VP-CST services must submit an IMPACT application or modification to add the necessary Specialty/Subspecialty combinations consistent with the table below.

 

Table 1. IMPACT Enrollment Guide – VP-CST Services 

Enrollment TypeProvider TypeSpecialty

Subspecialty

 

Facility, Agency, Organization (FAO)Community Mental Health CenterTeam Based ServicesViolence Prevention Community Support Team
Behavioral Health ClinicBHC Team Based ServicesViolence Prevention Community Support Team

 

Following the submission of an IMPACT application/modification for VP-CST services, providers will receive an email from the University of Illinois, Office of Medicaid Innovation with instructions for completing the necessary program approval process.

 

Collaboration Expectations 

VP-CST services are one component of the comprehensive approach to ending Illinois' firearm violence epidemic envisioned under the Reimagine Public Safety Act. Providers of VP-CST services must establish and clearly communicate processes for accepting referrals for VP-CST services from local organizations funded by the Department of Human Services' Office of Firearm Violence Prevention (OFVP) and from local emergency departments treating customers who have experienced firearm violence. 

Providers of VP-CST services will be expected to provide ongoing implementation feedback to the Department and the OFVP, with the goal of informing future enhancements to the violence prevention system of care. VP-CST providers are also expected to establish and maintain collaborative relationships with other local stakeholders and entities working to reduce firearm violence, including participating in meetings convened by organizations funded by the OFVP.

 

Reimbursement 

Information regarding the billing codes and rates for VP-CST services is provided in the table below:

 

Table 2. VP-CST Service Codes and Rates 

Service NameHCPC
Code
ModifiersUnitsState MaxAdd-OnTotal State Max
12On-SiteOff-SiteOn-SiteOff-Site
VP-CST IndividualH0037* 1/4 hr$19.45$22.55$15.00$34.45$37.55
VP-CST GroupH0037HQ*1/4 hr$4.86$5.64$0.00$4.86$5.64

 

*Claims for VP-CST services must include a modifier corresponding the level of staff on the team delivering the service.   

The rate for VP-CST is inclusive of all the services from the CBS Handbook that a Mental Health Professional (MHP) can provide, except for Mobile Crisis Response, Crisis Stabilization, Mental Health Case Management, other services that require prescriber authorization, and other services that require a Program Approval within IMPACT.    

Questions regarding this notice may be directed to HFS.BHCompliance@illinois.gov.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs 


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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director