Date: March 13, 2023
To: Long Term Care - Specialized Mental Health Rehabilitation Facilities (SMHRF) Only
Re: Enhanced Rate for Court-Ordered Individuals
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Effective for dates of service on and after April 1, 2023, a $35 per resident per day add-on for an individual that has a Court-Ordered admission will be applied to new admissions to Specialized Mental Health Rehabilitation Facilities (SMHRF) that meet certain room occupancy and licensure finding factors. The add-on rate will be applicable for the resident for the duration of the Court-Ordered portion of the stay.
Parameters:
- The add-on rate is only available to facilities in which all rooms licensed through the Illinois Department of Public Health (DPH) are certified for single (1) or double (2) occupancy;
- The facility must not have any Level 4 – 6 findings in the past 12 months;
- The facility must meet programmatic requirements associated with care, treatment, and reporting to the court.
Expectations:
- The facility must provide timely 90-day progress reports to the court and the Department of Human Services (DHS). DHS will provide training and will be available to provide technical assistance.
- The facility must be a liaison with the DHS Community Forensic staff on all issues, concerns that arise with customers at the time of the issue and on a quarterly basis.
- The facility must evaluate the customer for the "Comprehensive Class Member Transition Program", as appropriate and in consultation with DHS for Not Guilty by Reason of Insanity (NGRI) customers.
Claim Submittal:
This add-on will be paid in addition to the single or double occupancy room add-on amounts. To receive the new add-on payment for the court-ordered individual, the facility must submit the claim using:
- Revenue Code 0119 (single occupancy room)
- Revenue Code 0129 (double occupancy room)
Leave of absence (bed reserve) days are not eligible for the add-on rate.
The new add-on is currently being programmed in the pricing system. Upon completion of the programming, providers will be notified, and claims will be adjusted systematically. The above information has been shared with the managed care organization (MCO) plans for incorporation into their claims processing systems.
Questions regarding payment by Managed Care plans should be directed to the appropriate plan.
Questions regarding this notice may be directed to the Bureau of Long Term Care at
1-844-528-8444.
Kelly Cunningham, Administrator
Division of Medical Programs
