Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.453 - Community-based Mental Health Service Definitions and Professional Qualifications

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Inter-Departmental Collaboration and Administration. The Department of Human
				Services-Division of Mental Health (DHS-DMH) and the Department of Children and
				Family Services (DCFS), pursuant to an executed interagency agreement, shall
				ensure the administration and coordination of mental health services.
b) Community-based Mental Health Professional
				Qualifications. All individuals qualified under this Section to provide
				services shall only provide the services listed in this Section within their
				scope of practice, as defined or by federal or state law, regulation or policy.
1) All professional definitions provided in
				this subsection (b) are only applicable to services detailed in this
				Section.
2) Independent
				Practitioner (IP). An IP, as defined by Section
				140.452(a)(3),
				may receive direct reimbursement for services pursuant to Section
				140.452(e).
				All other credentialed staff detailed in this Section except Peer Support
				Workers as defined by subsection (b)(7), must be employees of a Community
				Mental Health Center or Behavioral Health Clinic that may qualify for
				reimbursement for the services provided.
3) Licensed Practitioner of the Healing Arts
				(LPHA). An LPHA is defined as:
A) A physician
				who holds a valid license in the state of practice and is legally authorized
				under state law or rule to practice medicine in all its branches, so long as
				that practice is not in conflict with the Medical Practice Act of
				l987;
B) An advanced practice nurse
				with psychiatric specialty that holds a valid license in the state of practice
				and is legally authorized under state law or rule to practice as an advanced
				practice nurse, so long as that practice is not in conflict with the Illinois
				Nurse Practice Act or the Medical Practice Act of 1987;
C) A clinical psychologist who holds a valid
				license in the state of practice and is legally authorized under state law or
				rule to practice as a clinical psychologist, so long as that practice is not in
				conflict with the Clinical Psychologist Licensing Act;
D) A licensed clinical professional counselor
				possessing a master's degree who holds a valid license in the state of practice
				and is legally authorized under state law or rule to practice as a licensed
				clinical professional counselor, so long as that practice is not in conflict
				with the Professional Counselor and Clinical Professional Counselor Licensing
				Act [225 ILCS 107 ];
E) A marriage
				and family therapist who holds a valid license in the state of practice and is
				legally authorized under state law or rule to practice as a marriage and family
				therapist, so long as that practice is not in conflict with the Marriage and
				Family Therapist Licensing Act [225 ILCS 55 ];
F) A clinical social worker possessing a
				master's or doctoral degree who holds a valid license in the state of practice
				and is legally authorized under state law or rule to practice as a social
				worker, so long as that practice is not in conflict with the Clinical Social
				Work and Social Work Practice Act.
4) Qualified Mental Health Professional
				(QMHP). A QMHP is defined as one of the following:
A) Any individual identified as an LPHA in
				subsection (b)(3);
B) A registered
				nurse who holds a valid license in the state of practice, is legally authorized
				under state law or rule to practice as a registered nurse, so long as that
				practice is not in conflict with the Illinois Nurse Practice Act, and has
				training in mental health services or one year of clinical experience, under
				supervision, in treating problems related to mental illness, or specialized
				training in the treatment of children and adolescents.
C) An occupational therapist who holds a
				valid license in the state of practice and is legally authorized under state
				law or rule to practice as an occupational therapist, so long as that practice
				is not in conflict with the Illinois Occupational Therapy Practice Act [225
				ILCS 75 ] with at least one year of clinical experience in a mental health
				setting. In the event the state of practice does not provide a legal authority
				for licensure, the individual must meet the requirements of 42 CFR 484.4 for an
				occupational therapist.
D) An
				individual possessing a master's or doctoral degree in counseling and guidance,
				rehabilitation counseling, social work, psychology, pastoral counseling, family
				therapy, or a related field and has:
i)
				Successfully completed 1,000 hours of practicum and/or internship under
				clinical and educational supervision; or
ii) One year of documented clinical
				experience under the supervision of a QMHP.
5) Mental Health Professional (MHP)
A) An MHP is defined as one of the following:
i) Any individual identified as a QMHP in
				subsection (b)(4); or
ii) An
				individual meeting the following qualifications, delivering services under the
				supervision of a QMHP:
* An individual possessing a bachelor's degree in counseling
				  and guidance, rehabilitation counseling, social work, education, vocational
				  counseling, psychology, pastoral counseling, family therapy, or related human
				  service field;
* An individual possessing a bachelor's degree in any field,
				  other than those identified in subsection (b)(4)(D), with two years of
				  documented clinical experience in a mental health setting under the supervision
				  of a QMHP;
* A practical nurse who holds a valid license in the state of
				  practice and is legally authorized under state law or rule to practice as a
				  practical nurse, so long as that practice is not in conflict with the Illinois
				  Nurse Practice Act;
* An individual possessing a certificate of psychiatric
				  rehabilitation from a DHS-approved program, plus a high school diploma or GED,
				  plus two years' documented experience in providing mental health
				  services;
* A recovery support specialist with a current certification
				  from the Illinois Alcohol and Other Drug Abuse Professional Certification
				  Association, Inc.;
* A family partnership professional with current
				  certification from the Illinois Alcohol and Other Drug Abuse Professional
				  Certification Association, Inc.;
* An occupational therapy assistant with at least one year of
				  experience in a mental health setting that holds a valid license in the state
				  of practice and is legally authorized under state law or rule to practice as an
				  occupational therapist assistant, so long as that practice is not in conflict
				  with the Illinois Occupational Therapy Practice Act. In the event the state of
				  practice does not provide a legal authority for licensure, the individual must
				  meet the requirements of 42 CFR 484.4 for an occupational therapist; or
* An individual with a high school diploma or GED and a
				  minimum of five years documented clinical experience in mental health or human
				  services.
* An individual who has completed a behavioral health
				  technician or other psychiatric training certification through the Medical
				  Education and Training Campus in Fort Sam Houston, Texas, with one year
				  documented clinical experience in a mental health setting under supervision of
				  a QMHP.
B) Any
				individual designated as an MHP prior to July 1, 2011 shall retain that
				designation throughout the continual course of his/her employment. In the event
				that the individual leaves the current employer, the designation is no longer
				valid.
6) Rehabilitative
				Services Associate (RSA). An RSA is defined as one of the following:
A) Any individual identified as a QMHP in
				subsection (b)(4); or
B) An
				individual meeting the following qualifications, delivering services under the
				supervision of a QMHP:
i) Any individual
				identified as an MHP in subsection (b)(5);
ii) Any individual who is 21 years of age and
				demonstrates all of the following:
* Skill in the delivery of rehabilitative services to adults
				  or children;
* The ability to work within a provider agency's structure
				  and accept supervision; and
* The ability to work constructively with individuals
				  receiving services, other providers of service, and the community; or,
iii) An individual qualified as a
				PSW pursuant to subsection (b)(7).
7) Peer Support Worker (PSW). A PSW delivers
				services from the peer perspective, under the supervision of a QMHP, and must
				be an individual who:
A) Is 21 years of
				age;
B) Has individual lived
				experience, or experience as a caregiver of a child, with behavioral health
				needs;
C) Demonstrates the ability
				to work within agency structure, accept supervision, and participate as a
				member of a multi-disciplinary team, when applicable; and
D) Has completed a Department-approved peer
				support training or certification process.