Rule 132 Medicaid Community
Mental Health Service Program
Training presented May 2007
1
History and development
process

Why changes:
– Shift focus to recovery and resiliency
– Conform to CMMS requirements
– Continue efforts started in 2004 to improve rule
How changes made:
Establish System Restructuring Initiative (SRI)
Establish workgroup on each new service
Review and incorporate other state experiences
Research evidence-based practices/best practices
Review recent CMMS audits and actions
Training presented May 2007
2
Underlying Vision of Recovery
and Resilience

Fundamental components and role of
services in supporting recovery and
resilience can be found at
www.dhs.state.il.us/revisedRule132/
Training presented May 2007
3
Objectives for today
– Understand why and how Rule 132 was amended
– Understand how Rule 132 services support the
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fundamental principles of recovery and resilience
Understand general changes in Rule 132
Understand changed requirements of existing Rule 132
services
Understand requirements of new and substantially
changed services in Rule 132
Understand general billing changes
Understand transition requirements
Present questions
Training presented May 2007
4
Handouts and Reference
Materials

Handouts:
– Agenda
– PowerPoint presentation
– Question cards
– Evaluation
Reference Materials:
Found at www.dhs.state.il.us/revisedRule132/
Adopted Rule 132
Crosswalk (now known as Service Definition and
Reimbursement Guide)
Guidelines, Instructions and Checklist
Summary of rule changes
Training presented May 2007
5
Certification Process

All currently certified providers will receive
new certificates
 Process for adding new services
 Providers now certified for therapeutic
behavioral services or skills training and
development will be automatically certified
for community support individual and group
Training presented May 2007
6
Certification Process (cont.)

If now certified for skills training and
development or therapeutic behavioral services
and have CILA (620), supervised residential (830)
or crisis residential (860) – will be automatically
certified for community support residential
 If now certified for therapeutic behavioral services
and comprehensive services – will be
automatically certified for community support
residential
Training presented May 2007
7
Transition Issues
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Rule allows three month transition period for
documentation
Treatment plans that currently have therapeutic
behavioral service or skills training and development
(ind/group) identified have until 9/30/07 to modify
plans to community support (individual or group).
Providers may bill for CSI or CSG during these three
months
Effective 7/1/07 services provided must meet CSI and
CSG definition and service notes must indicate CSI or
CSG
Training presented May 2007
8
Transition (cont.)
Mental health assessments – must be
updated by 6/30/2008
 Treatment Plans

– Must be updated by 9/30/07
– May be updated with signed & dated
modification
– 7/1/07 – provision, billing & documentation of
services must be for revised rule services even
when not yet in ITP
Training presented May 2007
9
Topics for future and separate
discussions

DCFS specific transition
 DHS/DMH contract requirements
Training presented May 2007
10
Rates, Billing and Coding
Changes

Rates
– Minor rate changes for services unaffected by the
revisions to Rule 132
– Rates for community support (group and individual)
and psychosocial rehabilitation (group and individual)
based on the rendering provider (RSA, MHP, QMHP)
– Rates for community support team and evidence-based
assertive community treatment based upon
interdisciplinary teams
– Rates for transition ACT are current rates
Training presented May 2007
11
Rates, Billing and Coding
Changes (cont.)

General billing issues
– Bills with dates of service on or after 7/1/2007
will be rejected for:
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Day treatment
Activity therapy
Skills training and development
Therapeutic behavioral services
– Bills for these services with earlier dates of
service will still be processed
Training presented May 2007
12
Rates, Billing and Coding
Changes (cont.)

Coding changes
– DHS activity codes and HIPAA standard
procedure codes are in the Services Definition
and Reimbursement Guide
(www.dhs.state.il.us/revisedRule132/)
– Each state agency has more specific
instructions on billing and payment to be
addressed in later training
Training presented May 2007
13
Training Follow-up and Next
Steps

Moderated conference calls
– Billing and Coding, May 29, 10 am – noon
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1(800)640-9765
Passcode: 17862946
– Non-Medicaid Vocational Service
– Non-Medicaid Outreach & Engagement

Technical assistance
– ACT/CST decision support tools
– PSR decision support tool

Q & A via dhsmh@dhs.state.il.us
Training presented May 2007
14
General Changes
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Definition of Licensed Clinician
Definition of MHP
Definition of QMHP (still includes LPHA)
Definition of off-site
Medicare certification status
Consequence of Medicare decertification
Plan for clinical supervision of all non-licensed
staff
Training presented May 2007
15
Summary of Service Changes

Mental health assessment
 Treatment plan development, review and
modification
 Therapy/counseling
 Skills training and development
Training presented May 2007
16
Summary of Service Changes
(cont.)

Therapeutic behavioral services
 Mental health day treatment
 Mental health intensive outpatient
 Activity therapy
 Intensive family-based services
Training presented May 2007
17
Changes to Mental Health
Assessment (132.148a)

Client preferences
 Name and contact information for primary
care physician
 Completion within 30 days of first face-toface contact
 Annual update
 MHAs must be updated by 6/30/08
 Medical necessity documentation
Training presented May 2007
18
Changes to Treatment Plan
Development, Review and
Modification (132.148c)
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Progress note if no client signature
Frequency of services – included by 9/30/07
Six month review includes review of goals for
continuing care with client or guardian
Must be updated by 9/30/07 – may be done with a
signed and dated modification
Before providing new services – must be in ITP
Training presented May 2007
19
Changes to Therapy/Counseling
(132.150e)


Strengthen definition to distinguish focus on
psychodynamic approach as opposed to skills development
that is community support or psychosocial rehabilitation
Examples of therapy/counseling:
– Cognitive behavioral therapy
– Functional family therapy
– Motivational enhancement therapy
– Trauma counseling
– Anger management
– Sexual offender treatment
Training presented May 2007
20
Skills Training and
Development

Service components now part of community
support services and psychosocial
rehabilitation
 Service name deleted and will not be paid
for if delivered beginning 7/1/2007
 Automatically certified to provide
community support individual and group
effective 7/1/2007
Training presented May 2007
21
Therapeutic Behavioral
Services

Service components now part of community
support services and psychosocial
rehabilitation
 Service name deleted and will not be paid
for if delivered beginning 7/1/2007
 Automatically certified to provide
community support individual and group
effective 7/1/2007
Training presented May 2007
22
Mental Health Day Treatment

Service no longer in treatment taxonomy
 Service name deleted and will not be paid
for if delivered beginning 7/1/2007
 Providers encouraged to become certified to
provide psychosocial rehabilitation and
community support (individual & group)
Training presented May 2007
23
Activity Therapy

Service no longer in treatment taxonomy
 Service name deleted and will not be paid
for if delivered beginning 7/1/2007
 Providers encouraged to become certified to
provide community support (individual &
group)
Training presented May 2007
24
Intensive Family- Based
Services

Service no longer in Medicaid state plan or
treatment taxonomy
 Service name deleted and will not be paid
for if delivered on or after July 1, 2007
 Activities provided under this service may
be billable as other rule 132 services
Training presented May 2007
25
Changes to Mental Health
Intensive Outpatient
(132.150l)

May be provided to clients at risk of
hospitalization
Training presented May 2007
26
Questions
Training presented May 2007
27
New or Substantially Changed
Services
Case Management – Mental Health
 Community support – individual
 Community support – group
 Community support – residential
 Community support – team
 Assertive community treatment
 Psychosocial rehabilitation

Training presented May 2007
28

Unless otherwise specified, providers must
apply for certification of all new and
substantially changed services, with the
exception of case management, in order to
provide them effective 7/1/2007.
Training presented May 2007
29
Changes to Case Management
Services (132.165)
Definition narrowed – active intervention
components moved to community support
Case management:
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Identifies resource needs
Facilitates access/linkage
Advocates
Coordinates
Does not include provision of rehabilitation services
Training presented May 2007
30
Changes to Case
Management (cont.)
Case management may be provided for 30 days
immediately preceding completion of the
mental health assessment
Includes administering of LOCUS – DHS only
Training presented May 2007
31
Case Management (cont.)

Case management vs. Community support:
– Case management does for the client
– Community support teaches the client how to
do for self
Training presented May 2007
32
Community Support

Necessary mental health rehabilitation
intervention and supports:
– To build capacity with the person to achieve their self-
identified rehabilitative, resiliency and recovery goals
– Designed to meet the following types of treatment
support needs of the person:
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Educational
Residential
Co-Occurring Disorders
Social
Vocational
Mental health
Financial
Others
Training presented May 2007
33
Community Support –
Individual (132.150f)
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Provided face-to-face, by telephone or video conference
At least 60% delivered in natural settings
Delivered by at least RSA
Not provided to clients receiving community support team
or assertive community treatment except during transition
If now certified for skills training and development or
therapeutic behavioral services – will be automatically
certified for community support individual
Training presented May 2007
34
Community Support – Group
(132.150g)
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Provided face-to-face in group settings ranging in size
from 2 to 15
At least 60% delivered in natural settings
Delivered by at least RSA
Not provided to clients receiving assertive community
treatment except during transition
If now certified for skills training and development or
therapeutic behavioral services – will be automatically
certified for community support group
Training presented May 2007
35
Community Support –
Residential (132.150h)
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Provided face-to-face, by telephone or video
conference in group or individual settings
Provided only to clients in public payer designated
residential settings
This services must be provided in the residential
setting
Services in other settings may be billable, but not
as CSR
Delivered by at least RSA
Training presented May 2007
36
Community Support –
Residential (cont.)

If now certified for skills training and
development or therapeutic behavioral services
and have CILA (620), supervised residential (830)
or crisis residential (860) – will be automatically
certified for community support residential
 If now certified for therapeutic behavioral services
and comprehensive services – will be
automatically certified for community support
residential
Training presented May 2007
37
Community Support – Team
(132.150i)
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Provided face-to-face, by telephone or video
conference to client or family member
At least 60% delivered in natural settings
Client-to-staff ratio - 18 to 1 in program not in any
specific group
No group rate – participation in group activities
may be community support group
More than one staff member of the team engaged
in direct service to client
Training presented May 2007
38
Community Support – Team
(cont.)
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Client must meet at least three eligibility criteria in
132.150i)4)
Delivered by a team of no fewer than 3 staff: team leader
who is a QMHP & two other staff of which one is
preferably someone in recovery
Service must be provided and billed only by one of the
client’s team members at any given time
Not provided to clients receiving assertive community
treatment or community support individual except during
transition
Training presented May 2007
39
Questions
Training presented May 2007
40
Assertive Community
Treatment (132.150j)
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Definition
ACT services must be prior authorized
Provided face-to-face, by telephone or video
conference
75% of service provided out of office
Clients 18 or older
Not provided in combination with other 132
services except:
– During transition to another level of care
– To client in Crisis residential
Training presented May 2007
41
Assertive Community
Treatment (cont.)

Crisis services for clients in ACT must be
provided by ACT team
 Client in ACT cannot receive services from
any staff outside ACT team except during
transition
 Available 24 hours/day, 7 days/week
Training presented May 2007
42
Assertive Community
Treatment (cont.)

Provided by at least 6 person interdisciplinary
team led by licensed clinician
 Team must include psychiatrist, nurse, program
assistant and staff:
– With special training & certification in substance abuse
treatment and/or co-occurring mental health and
substance abuse disorders
– In recovery
– With special training in rehabilitation counseling
Training presented May 2007
43
Assertive Community
Treatment (cont.)

Team shall include a total complement of
members; if any team member resigns or is on
leave, the team will be considered incomplete if
the team member is not replaced within 31 days
 If team is not complete on the 32nd day:
– Other services may be provided to the client per her/his
ITP
– Bills for ACT will not be acceptable
Training presented May 2007
44
Planning for New Assertive
Community Treatment

By 6/30/07 providers must declare intent to
convert to evidenced-based ACT & projected date
for recertification (no later than 9/30/07)
 New clients entering effective 7/1/07 must meet
new requirements
 ACT must be re-certified and services must be
authorized as meeting new requirements
Training presented May 2007
45
Converting an Assertive
Community Treatment Team

By 6/30/07 providers must declare intent to
convert existing team to another service
(conversion must be no later than 9/30/07)
 No new clients will be added to existing
teams who plan to convert to another
service(s)
 Between 7/1/07 and the conversion date,
provider may bill at current ACT rate
Training presented May 2007
46
Other ACT Conversion Issues

Region offices will create register of
existing ACT clients prior to 6/30/07
 Region offices will authorize ACT services
compliant with new rule
 BALC will recertify ACT when compliant
with new rule
 Current rates will apply to service provided
prior to recertification date
Training presented May 2007
47
Questions
Training presented May 2007
48
Psychosocial Rehabilitation
(132.150k)

Definition
 Clients 18 or older
 Facility based – no off-site billing
 Available at least 25 hours/week at least 4
days/week
 Adjunct service to community support
 All providers certified for PSR must also be
certified for community support
Training presented May 2007
49
Psychosocial Rehabilitation
(cont.)
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Program director must be at least QMHP
Delivered by at least an RSA
Staff to client ratio shall not exceed 1 to 15
May not be provided in combination with
assertive community treatment (except during
transition to ACT), intensive outpatient or
hospital-based psychiatric services type A
Document each session of service
Training presented May 2007
50
Questions
Training presented May 2007
51
Vocational Engagement
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Definition
Provided face to face, by telephone or video conference in individual
or group settings
Minimal staff requirement – RSA
Provided to adults and adolescents age 14 & over
Goal for employment or preparation for employment must be on ITP
Does not include provider-based pre-vocational programs or
educational programs that do not result in credentials recognized by an
employer
Activities related to employment that may be viewed in terms of the
client’s broader rehabilitative or social functioning skills & are not job
specific should be expressed in those terms and billed as Medicaidcovered services
Training presented May 2007
52
Vocational Assessment
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Definition
Provided face to face, by telephone or video conference
Minimal staff requirement – RSA
Provided to adults and adolescents age 14 & over
Client’s vocational goals should be integrated in the
treatment plan
Does not include pre-vocational work experiences or
simulated/situational work experiences at the provider’s
site
Training presented May 2007
53
Job Finding Supports
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Definition
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Provided face to face, by telephone or video
conference in individual or group settings
At least 40% delivered in natural settings
Minimal staff requirement – RSA
Provided to adults and adolescents age 14 & over
This does not include general job development
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Training presented May 2007
54
Job Retention Supports
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Definition
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Provided face to face, by telephone or video conference in
individual or group settings
At least 40% delivered in natural settings
Minimal staff requirement – RSA
Provided to adults and adolescents age 14 & over
Interventions must be specific to work and the job
Therapeutic supports to help individuals manage
symptoms as they work toward achieving recovery goals
should be distinguished from this service
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Training presented May 2007
55
Job Leaving/Termination
Supports
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Definition

Provided face to face, by telephone or video
conference in individual or group settings
 Minimal staff requirement – RSA
 Provided to adults and adolescents age 14 & over
 Job loss is not a reason to discontinue participation
in supported employment
Training presented May 2007
56
Outreach and Engagement
&
Stakeholder Education
Training presented May 2007
57
Outreach and Engagement &
Stakeholder Education
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No prior authorization needed
Funded with state dollars only
No new contract dollars involved
Target adults, children or SASS
Not for PATH or federally funded projects
Limited to 1% of contract billable total
Billing beyond 1% with written approval from
region office
Training presented May 2007
58
Outreach and Engagement
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Definition
Provided face to face, by telephone or video
conference in individual or group settings
Minimal staff requirement – RSA
75% out of office
Service go to reach people with SMI/SMD on
streets, in shelters, in jail or prison, or isolated due
to refugee status, language, cultural, social barriers
Staff Dyad can be used for offsite activity
Training presented May 2007
59
Stakeholder Education
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Definition
Provided face-to-face or by video conference to
individual to groups
Minimal staff requirement – RSA
Service goal to support collaboration between DMH
providers and community stakeholders, fight stigma
and promote innovative access strategies
Staff Dyad permitted when second staff person in
person in recovery
Must be delivered in prepared event/session
Training presented May 2007
60
Questions
Training presented May 2007
61