State, mental health consumers
and providers reach accord    

Memorandum creates blueprint for transition to fee-for-service

[AUG. 18, 2004]  SPRINGFIELD -- After months of discussion about the appropriate way to convert community mental health services in Illinois to a fee-for-service payment structure, a pivotal group of service providers, consumers and consumer advocates, trade association representatives, and Department of Human Services staff have reached a consensus on how to proceed.

The Strategic Restructuring Initiative Task Group is the new entity charged with guiding all parties through a process intended to maximize the state's ability to access federal funding, while ensuring that consumer access and provider financial stability are not adversely affected in the transition.

"I am confident that the diversity of the group members will provide the best possible basis for crafting a successful transition," said Department of Human Services Secretary Carol Adams, Ph.D. "When we have all of the stakeholders at the table -- consumers, families, community providers, advocacy groups and DHS staff -- the synergistic planning process is bound to produce a result that is better than any of us could create working in isolation."

Currently, community-based service providers receive grants, with a monthly upfront payment to support agency service delivery. Under fee-for-service, agencies would provide services to customers and then bill the state for reimbursement. The fee-for-service data needed to bill the state is detailed enough to allow the state to claim federal Medicaid matching dollars for qualifying services. This will bring millions in new revenue to Illinois annually.

The group has already approved a memorandum of agreement that addresses all aspects of planning and implementation.

Co-chair Linda Denson of Sankofa Organization of Illinois Inc. is an advocate and consumer leader. She describes the task group members as representing the "best and the brightest people working in our communities today," with their work creating "an invaluable chance to truly have a recovery-based system of care."

Co-chair Lora Thomas, executive director of the Illinois chapter of the National Alliance for the Mentally Ill, has an equally positive view of the process and its outcome. "I'm confident that the combined strength of these different communities, working together, can produce a plan that will give us an optimal solution, even in this time of fiscal constraints," she said.

Together Denson and Thomas will guide the group's progress over the next year as they work to articulate a shared vision and develop strategies to realize that vision.

The initial plan calls for a fee-for-service test phase and evaluation with 30 volunteer organizations, a communication procedure designed to ensure that all stakeholders may be equally involved in the ongoing process, and collaborative efforts to increase Medicaid claiming and achieve the fiscal 2005 target of $25 million. The task group will meet monthly.

In the introduction to their memo of agreement, the Department of Human Services and the Strategic Restructuring Initiative Task Group agreed that "above all, the mental health system must strive to become more recovery- and consumer-oriented, maintain fiscal sustainability, and improve efficiency and recovery."

A parallel effort intended to facilitate Medicaid claiming has reached a successful conclusion as well. Four state departments -- Children and Family Services, Corrections, Public Aid and Human Services -- joined forces to streamline and simplify Rule 132, which is key to facilitating mental health services claiming. The Joint Committee on Administrative Rules approved the revised rule, effective Aug. 1. The changes to Rule 132 will result in uniform access to mental health services, regardless of the agency funding the services, and consistency among the state agencies interacting with community mental health services providers.

For the full text of the memorandum, see http://www.dhs.state.il.us/ffs/dhs_ffs_memomh.asp.

System Restructuring Initiative Task Group members

Brian Allen, Mental Health Centers of Central Illinois, Springfield

Frank Anselmo, Community Behavioral Health Association, Springfield

Mike Boyle, Fayette Companies, Peoria

Mary Lynn Clarke, Illinois Hospital Association, Springfield

Luberta Conner, Community Mental Health Council, Chicago

Carroll Craddock, Health Advocates, Chicago

Linda Denson, Sankofa Organization of Illinois, Chicago

Freddy Garnett, Delta Center, Cairo

Carolyn Kopel, Illinois Department of Human Services

Frank Kopel, Illinois Department of Public Aid

Tony Kopera, Community Counseling Center of Chicago

Nanette Larson, Department of Human Services, Division of Mental Health

Orville Mercer, Chestnut Health Systems, Bloomington

Lena Raimondo, Thresholds, Chicago

Janet Stover, Illinois Association of Rehabilitation Facilities, Springfield

Haywood Suggs, Community Mental Health Council, Chicago

Lora Thomas, National Alliance for the Mentally Ill

Bob Vyverberg, Department of Human Services, Division of Mental Health

Frank Ware, Janet Wattles Center, Rockford

Don Wells, Human Service Center, Peoria

Tony Zipple, Thresholds, Chicago

[Illinois Department of Human Services
news release]