Transcript INDIVIDUAL CARE GRANT PROGRAM CHANGES: OVERVIEW

INDIVIDUAL CARE GRANT
PROGRAM CHANGES:
OVERVIEW
Seth Harkins, EdD
Director, ICG Program
Department of Human Services
Division of Mental Health
Why the Changes to the Individual
Care Grant (ICG) Program ?
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The Department of Human Services (DHS) / Division of
Mental Health (DMH) objectives for the changes in
ICG services include:
– Enhancement of recovery and resiliency focus
– Increase family participation
– Focus on least restrictive environment
– Outcomes
– Enhanced clinical care management
– Fee for service reimbursement
– Resume Medicaid billing
What Are the Changes to the
ICG Program?
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The Illinois Mental Health Collaborative for Access
and Choice (the Collaborative) provides
administrative and clinical services for sending and
receiving applications, reviewing applications,
making initial eligibility determinations, and
making continuing eligibility determinations
There is authorization of residential ICG nights of
stay services approximately every ninety days.
There is an increased emphasis on the Quarterly
Report.
What Are the Changes?
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There is an increased role of the Collaborative
Clinical Care Managers in partnering with
parents, ICG/SASS providers, and residential
providers.
Eligibility and levels of care are based on
medical necessity.
Medicaid eligibility for residential ICG clients
will increase after 90 days of residential care.
What’s the Same? What’s Different?
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The Same
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application process &
requirements
ICG eligibility criteria and
determination process
Quarterly and annual reviews
under Rule 135
Rates for services except for
application assistance and case
coordination
Payments to providers by
DHS/DMH
Case coordination role of
ICG.SASS worker
Active parent and family role
in treatment planning
Providers required to assist
with Medicaid applications
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Different
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Claims submitted to the
Collaborative
Service billed using DMH
Service Matrix and the old ICG
codes are no longer valid
Residential nights of care
require authorization for claim
payment
Residential providers required to
submit encounters for treatment
services provided during the
residential day - encounters
equal to at least 40% of the per
diem rate required
Consumer registrations into
DHS/DMH ROCS system not
required for consumers receiving
services on/after 4/1/09
What’s the Same? What’s Different?
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Different
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Collaborative Clinical Care
Manager in placement decisions
and treatment planning
Human Capital Development
(HCD) field offices aware of ICG
program and exclusion of family
income for Medicaid eligibility
at 90th day of treatment
Behavior Intervention
Management 97 M and Child
Support Services 72M require
authorization at $1570 and
$3500 respectively, per child in
place of case-by-case reviews.
Medical necessity reviews for
additional services
All providers and sites required
to be certified for Rule 132
services.