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FY11 DHS/DMH Community Mental Health Provider Manual

The DHS/DMH Community Mental Health Provider Manual is incorporated into the Provider Community Services Agreement via reference.

Table of Contents
 I. INTRODUCTION
  1. DHS/DMH Mission/Vision Statement
  2. Philosophy of Recovery
  3. Consumer and Family Handbook
  4. Description of Role: Background, History, and Goals of the Illinois Mental Health Collaborative
II. PROVIDER ELIGIBILITY
  1. DHS/DMH Community Services Contract-Attachment B
  2. Medicaid Enrollment
    1. Provider Enrollment
    2. Chapter CMH-100
    3. Chapter CMH-200 Children's Mental Health (SASS)
      1. Appendix
  3. Certification
    1. Medicaid Community Mental Health Tool (MMH)
  4. Forms to make Changes to Provider Database
  5. Continuity of Care
    1. Continuity of Care Agreement(FY11 content in development)
    2. USARF for Adolescents
    3. USARF for Adults
 III. CONSUMER ELIGIBILITY AND ENROLLMENT
  1. Consumer Eligibility, Enrollment and Benefit Status(New)
  2. Functional Impairment Scales
    1. Level of Care Utilization System (LOCUS)
    2. Columbia Impairment Scale
    3. Ohio Scales
    4. Devereux Scale
 IV. MENTAL HEALTH SERVICES
  1. Service Definitions and Requirements
    1. 59 ILAC 132, Revised 07.01.2008
    2. Service Definition and Reimbursement Guide, 07/01/2007
    3. Revised Rule 132 Training Presentation
    4. Rule 132 Questions and Answers
    5. PDA Day 2 Clinical Rehabilitation Training
  2. Utilization Management Program
    1. Overview of UM Program
    2. Medical Necessity Guidance (FY11 content in development)
  3. Capacity Grant, Definitions and Requirements
    1. Definitions
      1. Attachment B
  4. Forensic Services
    1. Training Manual for Unfit to Stand Trial (UST)
    2. Revised Forensic Handbook
  5. Child Mental Health Services (SASS)
    1. Chapter CMH-200 (Children's Mental Health/SASS)
      1. Appendix
  6. Pre-Admission Screening/Mental Health (PAS/MH)
    1. PAS/MH Contractor's Procedure Manual
 V. PROVIDER MONITORING
  1. Protocols
  2. Monitoring Tools
    1. Post-Payment Review
    2. Clinical Practice and Guidance Review
    3. Assertive Community Treatment (ACT)
    4. Community Support Team (CST)
    5. Psychosocial Rehabilitation (PSR)
  3. Provider Complaints and Appeals
    1. Medicaid-59 ILAC 132.44
    2. Non-Medicaid Grants Recovery Process-59 ILAC 103.130
 VI. CLAIMS SUBMISSION FOR COMMUNITY SERVICES
  1. Going Online: Tools and Resources
    1. ProviderConnect
    2. ProviderConnect Users Guide
    3. Providerconnect Helpful Resourcs
    4. Pseudo-RIN Information(FY11 content in development)
    5. Place of Service Crosswalk
    6. Service Modifier
    7. Service Matrix(FY11 content in development)
  2. Collaborative Software
    1. Direct Data Entry
    2. EDI Claims
      1. Claim Line Separation Logic
      2. Program Codes/Collaborative Software
  3. Third Party Software
    1. Batch Registration
    2. How to Submit Electronic Claims in HIPAA 837 Format
    3. Illinois 837 Companion Guide
    4. Illinois 835 Companion Guide V2 (9/22/08)
    5. HIPAA Advisory
      1. Where to Learn More About HIPAA
  4. Resources
    1. PaySpan© Health: Healthcare Payment and Remittance Advice (a free service to providers for EFT and ERA receipt)
    2. Payformance PowerPoint Illinois
  5. PAS Mental Health
    1. PAS/MH Manual
  6. SASS claims (direct submission to HFS)
    1. Chapter CMH-100, DHFS Handbook
    2. Chapter CMH-200, DHFS Handbook
    3. Chapter CMH-300, DHFS Handbook
 VII. ICG
  1. ICG Services Manual
  2. ICG Claims (refer to claims section)
  3. 59 ILAC 135
  4. Eligibility Criteria for the Individual Care Grant
  5. Frequently Asked Questions - ICG
 VIII. IMPORTANT REFERENCE AND RESOURCE DOCUMENTS
  1. Illinois Statutes
    1. Mental Health and Developmental Disabilities Confidentiality Act
    2. Mental Health and Developmental Disabilities Code
    3. Children's Mental Health Act of 2003
  2. Important Federal Policies, Regulations, and Reports
    1. Code of Federal Regulations (CFR)
    2. United States Code (USC)
    3. The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
    4. Surgeon General's Report on Mental Health, 1999
    5. President's New Freedom Commission's Report on Mental Health, 2003
  3. Accreditation Standards/Requirements
    1. Commission on Accreditation of Rehabilitation facilities (CARF)
    2. Joint Commission on Accreditation of Healthcare Organization
    3. Council on Quality and Leadership (The Council)
    4. Council on Accreditation of Services for Families and Children (COA)
    5. Healthcare Facilities Accreditation Program
  4. Illinois Provider Tools and Resources
    1. Management Information System Resources Tool
  5. Evidence Based Practices:
    1. Supported Employment: A Practical Guide for Practitioners and Supervisors. (Swanson, S.J., Becker, D.R., Drake, R.E., Merrens, M.R.)
    2. SAMHSA Registry of Evidence Based Practices
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