(As of April 2013)
At a Glance
- Partnerships between the Department of Healthcare and Family Services (Medicaid), Illinois Health Connect (the state’s Medicaid primary care case management program), and the state chapter of the American Academy of Pediatrics support screening and services for children
- Multiple billing codes support mental health and substance abuse screenings in primary care settings
- A cross-agency initiative—Screening, Assessment, and Support Services—provides prompt treatment and a single, statewide system for children and adolescents with acute behavioral health care needs
Introduction
Illinois has a robust system of screening for mental health and substance abuse available to children under the Medicaid children’s benefit (also known as the Early and Periodic, Screening Diagnostic, and Treatment benefit or EPSDT), as well as an innovative set of mental health support services for children. Mental health and substance abuse services for almost all Medicaid beneficiaries are available on a fee-for-service basis through Illinois Health Connect, the state’s primary care case management program. The Department of Healthcare and Family Services (HFS), which houses Medicaid, does encourage beneficiaries to receive services through community mental health centers, which bill Illinois Medicaid directly for services.
Under the 2003 Children’s Mental Health Act, which sought to create a “comprehensive, coordinated children’s mental health system,” Illinois has developed the Screening, Assessment, and Support Services (SASS) initiative. This initiative is designed to improve the coordination and delivery of mental health services to children and adolescents with acute mental health treatment needs. SASS often will direct children from hospital-based services to the community mental health centers so that they can be treated within the community.
Coordination and Collaboration
The SASS initiative for children and adolescents is a cooperative partnership between the Illinois Department of Children and Family Services, HFS, and the Department of Human Services. The initiative seeks to develop, through the three departments, a single, statewide system to serve children requiring public funding from one of the three agencies. The program features a single point of entry, Crisis and Referral Entry Service, (CARES) for all children entering the system and ensures that the children receive the appropriate services in the setting most conducive to their wellbeing.
The Illinois Chapter, American Academy of Pediatrics (ICAAP) has been an important partner to the state government. The Enhancing Developmentally Oriented Primary Care (EDOPC) partnership between the Advocate Health Care, Healthy Steps Program and ICAAP, an initiative partly funded by HFS to improve the delivery and financing of preventive health and developmental services for children birth to three, has worked to improve developmental screening rates in the state. HFS has worked recently with ICAAP to rewrite the Healthy Kids Handbook (Healthy Kids is Illinois’s name for the preventive component of the Medicaid children’s benefit.) ICAAP also worked with HFS as part of The Commonwealth Fund’s ABCD II project to develop a provider toolkit to help providers initiate referrals to Early Intervention services, and the ICAAP disseminated a developmental screening quality improvement initiative to pediatricians.
Screening, Assessment and Referrals
As part of The Commonwealth Fund’s ABCD II project, Illinois implemented two pilot projects using a coordinated community model and a third pilot that integrated screening and referral into its outreach program. Staff identified referral resources for PCPs by conducting statewide and community prevention assessments. Training curricula were developed on social-emotional development and perinatal depression and were provided for Medicaid Managed Care Organizations’ network providers and pediatric/family physician sites. Illinois also made numerous policy changes during the ABCD project, including: clarifying and encouraging the use of unbundled services for Medicaid reimbursement for developmental screenings; clarifying Medicaid policy to allow for two developmental screenings and one risk assessment on the same day; increasing reimbursement to providers for preventive EPSDT well child screening services; initiating collaborative MCO Performance Improvement Projects (PIPs) focused on the healthy social-emotional development of young children and perinatal depression; and implementing MCO contract requirements to focus on health outcomes, including promoting the healthy mental development of young children.
Illinois covers several types of behavioral health screening with an array of CPT codes. These codes include the:
- 96110 code for developmental screening,
- 96111 code for social emotional testing,
- 99420 code for screening for mental health, substance abuse and chronic conditions, as well as completion of the American Medical Association’s (AMA) Guidelines for Adolescent Preventive Services (GAPS) Younger Adolescent Questionnaire or the Middle Older Adolescent Questionnaire;
- 99420HD and H1000 codes for reimbursement for postpartum and prenatal depression screening.
The state details in the Healthy Kids Handbook the codes and the recommended screening tools to accompany those codes. The state also provides appendices (see appendices 3 and 4) to the EPSDT Provider Handbook that include a mental health screen for children ages 3 – 20, referral information to Division of Mental Health Certified Medicaid Providers by County, and substance abuse screening and referral resources. HFS’s policy on behavioral health risk assessments for children and adolescents was reiterated in an informational notice to physicians, nurses, FQHCs, hospitals, local education agencies and health departments, and school-based health centers in March 2013.
HFS has approved five substance abuse screening instruments for adolescents: the CRAFFT Screening Test; the Massachusetts Youth Screening Instrument (MAYSI-2); and three iterations of the Global Appraisal of Individual Needs (GAIN), the GAIN-Q, GAIN-SS (Recency), and GAIN-SS (Past Year). The provider handbook clarifies that adolescents screening positive for a substance use disorder should receive a comprehensive assessment of substance abuse from a well-trained professional. If the primary care physician performing the screen does not have the skills to conduct the substance abuse assessment, they are directed to make a referral for the comprehensive assessment. The GAIN has been approved by the HFS at the comprehensive assessment substance abuse tool for adolescents.
Treatment
Under the state’s Children’s Mental Health Act, the centerpiece of Illinois’s child mental health system for children with acute behavioral health needs is the SASS initiative. Parents, caregivers, or others who believe a child is having a mental health crisis can call the CARES phone line for access to a SASS provider. Within four hours of a CARES referral, the child is given a face-to-face screening and assessment via a process that involves use of the Childhood Severity of Psychiatric Illness decision support instrument, a mental status evaluation, an evaluation of a child’s ability to function in his environment and assessment of the child’s risk of harm to self or others, and a determination of the viability of meeting the treatment needs of the child in the community. Children who are eligible for public funding for behavioral health services and who meet acuity standards receive access to a range of SASS core services, including:
- Crisis intervention and stabilization services for a child in a psychiatric crisis;
- Facilitation of a child’s admission for hospitalization services when needed;
- Intensive outpatient services to stabilize a child in the community or when the child is discharged from inpatient treatment;
- Psychiatric resource to provide consultation on treatment issues, facilitate crisis stabilization with priority medication assessment and management if appropriate, facilitate utilization of intensive community based services, and make referrals for specialty and laboratory testing when indicated;
- Psychotropic medication coverage;
- Care coordination, by which SASS acts as a conduit for the child and family between crisis intervention and ongoing care;
- A Family Resource Developer, a previous SASS consumer or a parent, guardian, or caregiver of a child with serious emotional disturbance that has successfully navigated one or more child-serving systems and can provide support to families; and
- Discharge and aftercare services.
SASS providers are also expected to provide education regarding resources and outreach to community agencies and users of the system.
A primary objective of the SASS system is to deflect children with behavioral health needs away from hospitalization. The state prefers to render these services in a community setting, through the state network of community mental health centers and SASS balances the child’s needs with what is available in the community. Illinois Medicaid does allow for direct billing of services provided by the community mental health centers. On its website Illinois HFS provides guidance around frequently asked questions, provider resources, claims submission, and direct billing.
Children with behavioral health treatment needs that do not rise to the level of acuity required for participation in the SASS initiative can receive care from community mental health centers, which can be reimbursed by Medicaid for a range of services. The state’s Community Mental Health Services Service Definition and Reimbursement Guide offers providers service descriptions, describes the applicable populations for each service, lists applicable reimbursement codes, and provides additional information.
School-based/linked health centers also play a role in the state’s mental health care delivery system for children. HFS recommends that these centers include clinically trained mental health practitioners (master’s level social worker, psychologist, certified psychiatric nurse, or mental health staff) to provide individual assessment, treatment, and referral, as well as group and family counseling.
Acknowledgements
The authors wish to thank the many state officials and stakeholders who contributed to and reviewed the information in this document.
This document was prepared by NASHP for the Centers for Medicare & Medicaid Services (CMS) under a contract to NORC at the University of Chicago. It does not reflect the views of CMS.
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