Service definition:
Minimum staff requirement:
MHP
Example activities:
Services are provided to assist in an effective transition from nursing facilities to another setting consistent with the client's welfare and development.
Notes:
Entry into this service is a result of the PASRR process and subject to prior authorization by DHS.
When a client is being transitioned from a nursing facility, the mental health assessment (MH PASRR assessment) and the ITP (facility care plan) will be used to authorize the provision of this service and as the basis for the development of transition plans.
Individual limitation of 40 hours per year during the last 180 days of nursing facility stay or after transition to
community.
Applicable populations
5 Adults (21+) 5 Adults (18-20) Children
Specialized substitute care SASS Allowed mode(s) of delivery
5 Face-to-face 5 Individual 5 On-site
5 Videoconference 5 Off-site
5Telephone Group
Services provided to clients identified for transition from a nursing facility to the community.
Time spent planning with the staff of the nursing facility or the receiving living arrangement and community service providers.
Assisting client in completing paperwork for community resources.
Arranging or conducting pre- or post-placement visits. Time spent developing an aftercare service plan.
Time spent planning a client’s discharge and linkage from a nursing facility for continuing mental health services and community/family support.
Assisting the client or the client’s family or caregiver with the transition.
Post placement assessment of community stability.
Pre-service requirements
References
5 Medical 5 Mental health 5 Treatment necessity assessment plan
5 Prior authorization required (by DHS)
Rule: 89 Ill. Adm. Code 140.454(d) HIPAA: Case management
Reimbursement and coding summary
Modifier(s) DHS service activity code(s) HCPCS code (1) (2) (3) Place of service Notes Unit of service Rate per unit of service (n/a) T1016 HN 11 On-site; MHP ¼ hr. $ 16.65 (n/a) T1016 HN 12 Home; MHP ¼ hr. $ 19.31 (n/a) T1016 HN 99 Off-site; MHP ¼ hr. $ 19.31 (n/a) T1016 HO 11 On-site; QMHP ¼ hr. $ 18.02 (n/a) T1016 HO 12 Home; QMHP ¼ hr. $ 20.90 (n/a) T1016 HO 99 Off-site; QMHP ¼ hr. $ 20.90GROUP
D
SERVICEDevelopmental testing
MEDICAID (HFS only)Service definition:
Minimum staff requirement:
LPHA
Example activities:
Administration, interpretation, and reporting of
developmental testing. The testing of cognitive processes, visual motor responses, and abstractive abilities
accomplished by the combination of several types of testing procedures. It is expected that the administration of these tests will generate material that will be formulated into a report.
An objective screening tool (limited or extended) must meet the definition provided by the American Medical Association’s Current Procedural Terminology (CPT) and must be provided according to the instrument, including use of the instrument form as applicable.
Objective screening evaluates domains:
• Social emotional development
• Fine motor-adaptive development
• Language development
• Gross motor development.
Notes:
Applicable populations
Adults (21+) 5 Adults (18-20) 5 Children
Specialized substitute care SASS
Allowed mode(s) of delivery
5 Face-to-face 5 Individual 5 On-site
Videoconference 5 Off-site
Telephone Group
CPT 96110 (for examples refer to the Handbook for Healthy Kids Services, section HK-203.53 Developmental Screening Tools)
CPT 96111 (for examples refer to the Handbook for Healthy Kids Services, section HK-203.54 Developmental Evaluation Tools)
Pre-service requirements
References
Medical Mental health Treatment necessity assessment plan
Prior authorization required
Rule: 89 Ill. Adm. Code 140.454(e)
HIPAA: Developmental testing, with interpretation and report
Reimbursement and coding summary
Modifier(s) DHS service activity code HCPCS code (1) (2) (3) Place of service Notes Unit of service Rate per unit of service (n/a) 96110 11 On-site, limited Event $ 16.10 (n/a) 96110 99 Off-site, limited Event $ 16.10 (n/a) 96111 11 On-site, extended Event $ 16.10 (n/a) 96111 99 Off-site, extended Event $ 16.10GROUP
D
SERVICEMental health risk assessment
MEDICAID (HFS only)Service definition:
Minimum staff requirement:
LPHA
Example activities:
Administration and interpretation of health risk assessment instrument to be used for a perinatal depression screening if the woman is postpartum.
Significant predictors for perinatal depression: Prenatal depression, severe stress, lack of social support, prenatal anxiety, poor marital relationship, domestic violence, history of previous depression, difficult infant temperament, single marital status, previous postpartum depression, family history of depression, prior stillborn, bereavement
Notes:
May not be billed in conjunction with a mental health assessment. The mental health assessment, being more comprehensive, should encompass an assessment of depression, as needed.
Applicable populations
Adults (21+) 5 Adults (18-20) 5 Children
Specialized substitute care SASS
Allowed mode(s) of delivery
5 Face-to-face 5 Individual 5 On-site
Videoconference 5 Off-site
Telephone Group
Edinburgh Postnatal Depression Scale Beck Depression Inventory
Primary Evaluation of Mental Disorders Patient Health Questionnaire
Pre-service requirements
References
Medical Mental health Treatment necessity assessment plan
Prior authorization required
Rule: 89 Ill. Adm. Code 140.454(e)
HIPAA: Administration and interpretation of health risk assessment
Reimbursement and coding summary
Modifier(s) DHS service activity code HCPCS code (1) (2) (3) Place of service Notes Unit of service Rate per unit of service (n/a) 99420 HD 11 On-site Event $ 14.60 (n/a) 99420 HD 99 Off-site Event $ 14.60GROUP
D
SERVICEPrenatal care at-risk assessment
MEDICAID (HFS only)Service definition:
Minimum staff requirement:
LPHA
Example activities:
Administration and interpretation of health risk assessment instrument to be used for a prenatal depression screening if the woman is pregnant.
Significant predictors for Perinatal Depression: Prenatal depression, severe stress, lack of social support, prenatal anxiety, poor marital relationship, domestic violence, history of previous depression, difficult infant temperament, single marital status, previous postpartum depression, family history of depression, prior stillborn, bereavement
Notes:
May not be billed in conjunction with a mental health assessment. The mental health assessment, being more comprehensive, should encompass an assessment of depression, as needed.
Applicable populations
5 Adults (21+) 5 Adults (18-20) 5 Children
Specialized substitute care SASS
Allowed mode(s) of delivery
5 Face-to-face 5 Individual 5 On-site
Videoconference 5 Off-site
Telephone Group
Edinburgh Postnatal Depression Scale. Beck Depression Inventory.
Primary Evaluation of Mental Disorders Patient Health Questionnaire.
Postpartum Depression Screening Scale (PPSS).
Pre-service requirements
References
Medical Mental health Treatment necessity assessment plan
Prior authorization required
Rule: 89 Ill. Adm. Code 140.454(e) HIPAA: Prenatal care, at-risk assessment
Reimbursement and coding summary
Modifier(s) DHS service activity code HCPCS code (1) (2) (3) Place of service Notes Unit of service Rate per unit of service (n/a) H1000 11 On-site Event $ 14.60 (n/a) H1000 99 Off-site Event $ 14.60Glossary
Acronyms
Professional staff acronyms
APN Advanced practice nurse
LCPC Licensed clinical professional counselor LCSW Licensed clinical social worker
LMFT Licensed marriage and family therapist LPN Licensed practical nurse
LPHA Licensed practitioner of the healing arts MHP Mental health professional
QMHP Qualified mental health professional RN Registered nurse
RSA Rehabilitative services associate