1. Rule 132 Medicaid Community Mental Health Service Program
Training presented May 2007

2. 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

3. Underlying Vision of Recovery and Resilience
Fundamental components and role of services in supporting recovery and resilience can be found at
Training presented May 2007

4. Training presented May 2007
Objectives for today
Understand why and how Rule 132 was amended
Understand how Rule 132 services support the 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

5. Handouts and Reference Materials
Agenda
PowerPoint presentation
Question cards
Evaluation
Reference Materials:
Found at
Adopted Rule 132
Crosswalk (now known as Service Definition and Reimbursement Guide)
Guidelines, Instructions and Checklist
Summary of rule changes
Training presented May 2007

6. 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

7. 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

8. Training presented May 2007
Transition Issues
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

9. Training presented May 2007
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

10. Topics for future and separate discussions
DCFS specific transition
DHS/DMH contract requirements
Training presented May 2007

11. Rates, Billing and Coding Changes
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

12. Rates, Billing and Coding Changes (cont.)
General billing issues
Bills with dates of service on or after 7/1/2007 will be rejected for:
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

13. Rates, Billing and Coding Changes (cont.)
DHS activity codes and HIPAA standard procedure codes are in the Services Definition and Reimbursement Guide (
Each state agency has more specific instructions on billing and payment to be addressed in later training
Training presented May 2007

14. Training Follow-up and Next Steps
Moderated conference calls
Billing and Coding, May 29, 10 am – noon
1(800)
Passcode:
Non-Medicaid Vocational Service
Non-Medicaid Outreach & Engagement
Technical assistance
ACT/CST decision support tools
PSR decision support tool
Q & A via
Training presented May 2007

15. Training presented May 2007
General Changes
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

16. Summary of Service Changes
Mental health assessment
Treatment plan development, review and modification
Therapy/counseling
Skills training and development
Training presented May 2007

17. 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

18. Changes to Mental Health Assessment (132.148a)
Client preferences
Name and contact information for primary care physician
Completion within 30 days of first face-to-face contact
Annual update
MHAs must be updated by 6/30/08
Medical necessity documentation
Training presented May 2007

19. Training presented May 2007
Changes to Treatment Plan Development, Review and Modification ( c)
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

20. 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

21. 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

22. 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

23. 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

24. Training presented May 2007
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

25. 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

26. Changes to Mental Health Intensive Outpatient (132.150l)
May be provided to clients at risk of hospitalization
Training presented May 2007

27. Training presented May 2007
Questions
Training presented May 2007

28. 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

29. Training presented May 2007
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

30. Changes to Case Management Services (132.165)
Definition narrowed – active intervention components moved to community support
Case management:
Identifies resource needs
Facilitates access/linkage
Advocates
Coordinates
Does not include provision of rehabilitation services
Training presented May 2007

31. 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

32. 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

33. Training presented May 2007
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:
Educational Vocational
Residential Mental health
Co-Occurring Disorders Financial
Social Others
Training presented May 2007

34. Community Support – Individual (132.150f)
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

35. Community Support – Group (132.150g)
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

36. Community Support – Residential (132.150h)
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

37. 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

38. Community Support – Team (132.150i)
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

39. Community Support – Team (cont.)
Client must meet at least three eligibility criteria in i)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

40. Training presented May 2007
Questions
Training presented May 2007

41. Assertive Community Treatment (132.150j)
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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. Training presented May 2007
Questions
Training presented May 2007

49. 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

50. Psychosocial Rehabilitation (cont.)
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

51. Training presented May 2007
Questions
Training presented May 2007

52. Vocational Engagement
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 Medicaid-covered services
Training presented May 2007

53. Vocational Assessment
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

54. Training presented May 2007
Job Finding Supports
Definition
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
Training presented May 2007

55. Job Retention Supports
Definition
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
Training presented May 2007

56. Job Leaving/Termination Supports
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

57. Outreach and Engagement & Stakeholder Education
Training presented May 2007

58. Outreach and Engagement & Stakeholder Education
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

59. Outreach and Engagement
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

60. Stakeholder Education
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

61. Training presented May 2007
Questions
Training presented May 2007