Date: January 3, 2022
To: Community Mental Health Providers; Behavioral Health Clinics; Licensed Clinical Psychologists; Licensed Clinical Social Workers; Physicians
Re: Community-Based Behavioral Health Rate Increases Effective January 1, 2022
This notice informs providers of a proposed increase to community-based behavioral health services reimbursement rates effective January 1, 2022. This increase affects reimbursement rates for providers billing under both Medicaid fee-for-service (FFS) and the HealthChoice Illinois managed care plans for dates of service beginning January 1, 2022.
The Department is increasing the base rate for all Medicaid covered mental health services covered under the Community Based Services fee schedule by 2% with the following exceptions:
- The base rate for Assertive Community Treatment (ACT) services will be increased by 5%.
- The Telemedicine Originating Site Facility Fee (procedure code Q3014) and the state-funded Family Support Program (FSP) services will not receive a rate increase.
The Department is awaiting approval from the federal Centers for Medicare & Medicaid Services (CMS) before implementing the rate increases for FFS claims. Once CMS approval is given, the Department will complete a claims project to adjust any applicable FFS claims with dates of service on or after January 1, 2022 to pay the impacted claims at the increased reimbursement rate.
HealthChoice Illinois managed care plans are in the process of implementing the CBS fee schedule rate increases. Questions regarding the status of the implementation of rate increases by a HealthChoice Illinois managed care plan may be directed to the applicable managed care plan.
IMPORTANT REMINDER: It is Department policy that providers are to submit charges on claims that reflect the provider’s usual and customary charges to the general public for the services provided. Payment by the Department and by all HealthChoice Illinois managed care plans is made at the lesser of the provider charge or the maximum fee schedule rate. Applicable claims where the provider charge is less than the maximum fee schedule rate set as of January 1, 2022 will not be adjusted by the Department. Rather, the provider will be responsible for submitting replacement claims to receive payment at the increased reimbursement rates. Instructions for submittal of replacement claims may be found in the Chapter 300 Companion Guide for 837P transactions.
Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 or the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs
You may view the new Notice at the following link: https://www2.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx