INDIVIDUAL CARE GRANT PROGRAM CHANGES: OVERVIEW Seth Harkins, EdD Director, ICG Program Department of Human Services Division of Mental Health

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INDIVIDUAL CARE GRANT PROGRAM CHANGES
OVERVIEWSeth Harkins, EdDDirector, ICG
ProgramDepartment of Human ServicesDivision of
Mental Health
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Why the Changes to the Individual Care Grant
(ICG) Program ?

• 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

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What Are the Changes to the ICG Program?

• 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.

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What Are the Changes?

• 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.

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Whats the Same? Whats Different?

• The Same
• 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

• Different
• 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  old ICG codes are no longer valid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

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Whats the Same? Whats Different?

• Different
• 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.