305 ILCS 5/5-41
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

(Text of Section from P.A. 102-43)Sec. 5-41. Inpatient hospitalization for opioid-related overdose or withdrawal patients. Due to the disproportionately high opioid-related fatality rates among African Americans in under-resourced communities in Illinois, the lack of community resources, the comorbidities experienced by these patients, and the high rate of hospital inpatient recidivism associated with this population when improperly treated, the Department shall ensure that patients, whether enrolled under the Medical Assistance Fee For Service program or enrolled with a Medicaid Managed Care Organization, experiencing opioid-related overdose or withdrawal are admitted on an inpatient status and the provider shall be reimbursed accordingly, when deemed medically necessary, as determined by either the patient's primary care physician, or the physician or other practitioner responsible for the patient's care at the hospital to which the patient presents,  using criteria established by the American Society of Addiction Medicine.  If it is determined by the physician or other practitioner responsible for the patient's care at the hospital to which the patient presents, that a patient does not meet medical necessity criteria for the admission,  then the patient may be treated via observation and the provider shall seek reimbursement accordingly.  Nothing in this Section shall diminish the requirements of a provider to document medical necessity in the patient's record.  (Source: P.A. 102-43, eff. 7-6-21.)(Text of Section from P.A. 102-598)Sec. 5-41. Screening, Brief Intervention, and Referral to Treatment. As used in this Section, "SBIRT" means a comprehensive, integrated, public health approach to the delivery of early intervention and treatment  services for persons who are at risk of developing substance use disorders or have substance use disorders including, but not limited to, an addiction to alcohol, opioids,  tobacco, or cannabis.  SBIRT services include all of the following:(1) Screening to quickly assess the severity of     substance use and to identify the appropriate level of treatment.(2) Brief intervention focused on increasing insight     and awareness regarding substance use and motivation toward behavioral change.(3) Referral to treatment provided to those     identified as needing more extensive treatment with access to specialty care.SBIRT services may include, but are not limited to, the following settings and programs: primary care centers, hospital emergency rooms, hospital in-patient units,  trauma centers, community behavioral health programs, and other community settings that provide opportunities for early intervention with at-risk substance users before more severe  consequences occur.The Department of Healthcare and Family Services shall develop and seek federal approval of a SBIRT benefit for which  qualified providers shall be reimbursed under the medical assistance program.In conjunction with the Department of Human Services' Division of Substance Use Prevention and Recovery, the Department of Healthcare and  Family Services may develop a methodology and reimbursement rate for SBIRT services provided by qualified providers in approved  settings.For opioid specific SBIRT services provided in a hospital emergency department, the Department of Healthcare and  Family Services shall develop a bundled reimbursement  methodology and rate for a package of opioid treatment services, which include initiation of medication for the treatment of opioid use disorder in  the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services when necessary. This  package of opioid related services shall be billed on a separate claim and shall be reimbursed outside of the Enhanced Ambulatory Patient  Grouping system.  (Source: P.A. 102-598, eff. 1-1-22.)