October 2005

Overview

During fiscal year (FY) 2005, the Screening, Assessment, and Support Services (SASS) program provided mental health crisis services to an expanded population by including the Medicaid- and KidCare-eligible individuals under 21 years of age. This inter-agency coordinated effort streamlined the process of securing a consistent pre-admission screening to ensure that children and adolescents in psychiatric crisis receive the most appropriate care and follow-up services.

In FY2005, SASS served 16,825 children and adolescents across the state of Illinois. By including the Medicaid population in SASS, dollars previously spent for psychiatric hospitalization were, when appropriate, redirected to pay community mental health services. As of October 7, 2005, the Department of Healthcare and Family Services (HFS) had adjudicated (processed and accepted for payment) over $18 million dollars in community mental health services— $6.9 million was applied to the access and advance payments made at the beginning of fiscal years 2004 and 2005 and $11.3 million has been vouchered to community mental health providers. (Refer to attachment A, SASS Account Status report.)

Utilization and Billing

• During FY2005, CARES (the program’s toll-free “crisis line”) handled 85,184 calls. For FY2006 (i.e., through 10/17/2005), CARES has received 31,136 calls.

At the close of the first quarter of the second year of implementation, the SASS program appears to have stabilized. Enrollment, billed services, rejection rates, and programmatic clarifications are, in general, where we would expect them to be. Enrollment in the program, on any given day, averages at 3,625 children. The number of services adjudicated by HFS appears to have stabilized at 26,757 services per month since July 1, 2005 compared to 16,744 number of services per month during FY04. The rejection rate for SASS services billed to HFS is about the same as that for other classes of providers who bill the department and the reasons for rejection remain consistent. On July 1, 2005, two local area network (LAN) areas—38 and 45—covered during fiscal year 2005 by the Kenneth Young Center, were assigned to another provider. Leyden Family Services the provider of SASS for LANs 60 and 61 during fiscal year 2005 welcomed the opportunity to further expand services.

Technical Assistance

The Departments Healthcare and Family Services, Children and Family Services and Human Services continue to support the system by providing SASS and other community mental health providers technical assistance opportunities, including weekly technical assistance calls, a central SASS program helpline, a Web site, assigned contacts from the State departments, specific staff contacts to address billing issues, and regional meetings. The integrated efforts of the State departments along with providers has offered an open collaborative process in problem-solving as we continue into year two.

Program Evaluation

A third-party (Northwestern University) evaluation of the SASS program was conducted for the first year of program operation. The evaluation combined utilization data reported by SASS, billing data reported by HFS, CARES quality assurance data from DHS, CARES utilization data, and survey data from parents/other caregivers, SASS program directors, SASS agency directors, hospitals, and other non-SASS community behavioral health providers. The overall finding of the evaluator is that SASS has been a qualified success: SASS reached the target population, SASS decision making was clinically sound with 77% of the SASS determinations corresponding to the decision model; and SASS was effective as each episode of SASS care was associated with improved clinical functioning.

Advisory Workgroup

Throughout the first year, concerns due to the changes in, and expansion of, the SASS system were raised by SASS providers. In an effort to address concerns, the State departments convened a SASS Stakeholder Workgroup as a forum through which issues could be identified and solutions could be developed. (Refer to attachment B, Stakeholder Workgroup list.) Through that workgroup, the Departments continue to address and prioritize outstanding concerns. The Workgroup has elected to meet less frequently (it had met monthly) to devote more time to the practical work of the several substantive sub-groups that include even wider representation of SASS providers, hospitals, and consumers. The next meeting of the Stakeholders Workgroup will be held on 11/04/2005, in Springfield.

The Workgroup has prioritized its work for the current year into two areas, infrastructure enhancements/goals and program enhancements/goals.

Reimbursement

Through collaboration of the State departments and the workgroups, HFS has recently proposed changes to the reimbursement rates for community mental health services provided under “Rule 132” (59 Ill. Admin. Code 132) and added certain psychiatric physician services to the standard SASS service package (this affects those children and adolescents whose SASS services are the financial responsibility of the Department of Human Services, refer to Attachment C, Physician Services). The proposed rate increases address concerns raised by SASS (and other community mental health) providers regarding reimbursement for services delivered “off-site,” services requiring more than one staff to provide the care, the qualifications of staff, and the salary assumptions underlying the reimbursement rates. The changes take into consideration the results of the cost study, completed last June, that cost coverage for SASS services was weaker than coverage for the larger community mental health system (refer to Attachment D, Rate Table and Justification of Increase).

Attachment A (pdf)

Attachment B (pdf)

Attachment C (pdf)

Attachment D (pdf)