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FY10 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. The Illinois Mental Health collaborative for Access and Choice
    1. Description of Role: Background, History, and Goals of the Illinois Mental Health Collaborative
    2. Overview of Functions Retained by DHS/DMH and Delegated to the Collaborative
    3. How to Contact the Collaborative

II. COMMUNITY MENTAL HEALTH

  1. Individuals Served
    1. Target Population, Pages 12-15
    2. Eligible Population, Pages 1-11
  2. Recovery and Empowerment Handbook
    1. Rights, Responsibilities, Confidentiality, Pages 43-45
  3. Consumer Enrollment/Benefit Status
    1. Electronic Request for Recipient Identification Number (eRIN)
      1. Determining Consumer Public Benefit Status (MEDI)
      2. Enrollment/Registration in DHS/DMH Community Mental Health System
      3. New Consumers
      4. Required Information for Six-Month Updates for Existing Consumers
      5. Additional Consumer Forms Needed for Registration
        1. Attestation of Consumer Income-Sample Document
        2. Consumer Financial Eligibility
        3. Notice of Release of Personal Health Information to DHS/DMH (HIPAA)-Sample Document

III. CONSUMER MENTAL HEALTH SERVICES

  1. Medicaid Service Definitions and Requirements
    1. 59 ILAC 132, Revised 07.01.2008
    2. Service Definition and Reimbursement Guide, 07/01/2007
    3. Service Authorization Protocol
    4. DHS Diagnosis List for Rule 132
    5. Revised Rule 132 Training Presentation
    6. Rule 132 Questions and Answers
    7. PDA Day 2 Clinical Rehabilitation Training
  2. Team Based Services
    1. Assertive Community Treatment (ACT) Service Definition
      1. ACT EST IHR Request Form
      2. ACT Instructions
      3. ACT Appeals
      4. ACT Fidelity Tool
      5. ACT Notification of Discontinuance
    2. Community Support Team (CST) Service Definition
      1. CST EST IHR Request Form
      2. CST Instructions
      3. CST Appeals
      4. CST Fidelity Tool
      5. CST Notice of Discontinuance
    3. Crisis & Treatment Plans
      1. Sample Crisis Plans
        1. Plan 1
        2. Plan 2
    4. Level of Care Utilization Scale (LOCUS)
  3. Capacity Grant, Definitions and Requirements
    1. Definitions
      1. Attachment B
      2. Program Manual
    2. Billing/Reporting Instructions
  4. Individual Care Grants (ICG)
    1. 59 ILAC 135
    2. Eligibility Criteria for the Individual Care Grant
    3. Frequently Asked Questions - ICG
    4. Appeals
      1. Legal Aide Disabilities Guidebook - ICG
  5. Forensic Services
    1. Training Manual for Unfit to Stand Trial (UST)
    2. Revised Forensic Handbook
  6. Child Mental Health Services (SASS)
    1. Chapter CMH-200 (Children's Mental Health/SASS)
      1. Appendix
    2. Service Definition and Reimbursement Guide (effective 7/1/2007)
  7. Pre-Admission Screening/Mental Health (PAS/MH)
    1. PAS/MH Contractor's Procedure Manual

IV. 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

V. PROVIDER ELIGIBILITY

  1. Medicaid Enrollment
    1. Provider Enrollment
    2. Chapter CMH-100
    3. Chapter CMH-200 Children's Mental Health (SASS)
      1. Appendix
  2. Certification
    1. Medicaid Community Mental Health Tool (MMH)
  3. Continuity of Care
    1. Continuity of Care Agreement
    2. USARF for Adolescents
    3. USARF for Adults
  4. Changes to Provider Database Information
    1. Provider Notification Requirements

VI. SERVICE REPORTING AND BILLING FOR COMMUNITY SERVICES

  1. Medicaid, Non-Medicaid, and Capacity Grants
    1. For Services On or After 07.01.2008
      1. Going Online: Tools and Resources
        1. ProviderConnect
        2. ProviderConnect Users Guide
        3. ProviderConnect Helpful Resources
        4. Pseudo-RIN Information (04/15/09)
        5. Place of Service Crosswalk
        6. Service Modifier
        7. Service Matrix
      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
        6. 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
    2. For Services Prior to 07.01.2008
      1. ROCS Manual
      2. Question and Answer Documents from ROCS Teleconferences
      3. Error Codes and Resolution
        1. Error Code Explanation - DHFS Appendix (PDF)
        2. Error Codes and Their Resolution - DHS
  2. PAS Mental Health
    1. PAS/MH Manual
    2. DHS/DMH Community Services Contract - Attachment B
  3. Child Mental Health - Screening, Assessment, and Support Services (SASS)
    1. Chapter CMH-100, DHFS Handbook
    2. Chapter CMH-200, DHFS Handbook
    3. Chapter CMH-300, DHFS Handbook

VII. 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 (JCAHO)
    3. Council on Quality and Leadership (The Council)
    4. Council on Accreditation of Services for Families and Children (COA)
  4. Illinois Provider Tools and Resources
    1. Management Information System Resources Tool
    2. Assessment Requirements and Tools
      1. ACT/CST - Level of Care Utilization Scale (LOCUS)
      2. ICG - Ohio Youth Problems, Functioning, and Satisfaction Scales (Ohio Scales)
      3. Child and Adolescent - Columbia Impairment Scale
        [note: completion of the tool required through the web-based analysis system]
  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
    3. Rehabilitation Curriculum Guide 2008