Service Reimbursement

Section 141.215  Service Reimbursement a)         The CMH-HCBS services detailed in Section 141.220 shall be eligible for reimbursement pursuant to the Department's published fee schedule when the services are rendered by a provider approved by the Department and are: 1)         Recommended by a Licensed Practitioner of the Healing Arts (LPHA) in consultation with the participant's Child and Family Team (CFT), as applicable, on the participant's IATP; 2)         Provided to a participant for the maximum reduction of mental disability and restoration to the best possible functional level; 3)         Provided consistent with any service limitations, utilization controls, and prior authorizations established by the Department pursuant to 89 Ill. Adm. Code 140.40 or as detailed in this Part; and 4)         Provided for the direct benefit of the participant, which may include support provided to immediate caregivers of the eligible participant. b)         Reimbursement for CMH-HCBS services shall not: 1)         Be made for services provided to a participant at the same time as another service that is the same in nature and scope as the CMH-HCBS service, regardless of payer or program source, including Federal, state, local, and private entities; 2)         Include special education and related services defined in the Individuals with Disabilities Education Improvement Act of 2004 (20 U.S.C. 1400 et seq.) that otherwise are available to the participant through a local education agency, or vocational rehabilitation services that otherwise are available to the individual through a program funded under section 110 of the federal Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.); and 3)         Be made to relatives, legally responsible individuals, or legal guardians rendering services to the participant.