Section 132.10  Purpose

a)         The requirements set forth in this Part establish criteria for participation by providers in the Medicaid community mental health services program.  The Medicaid community mental health services program shall include the provision of specific mental health services pursuant to this Part supported financially in whole or in part by a public payer, as defined in Section 132.25.

b)         These requirements are for the purpose of assuring that clients receiving Medicaid community mental health services shall receive  services in accordance with this Part and in accordance with 42 CFR 440 and 456 (2003) for Medicaid-eligible clients.

c)         The Department of Human Services (DHS) and the Department of Children and Family Services (DCFS) and the Department of Corrections (DOC), pursuant to an executed interagency agreement with the Department of Healthcare and Family Services (HFS), shall use these requirements to certify, recertify, and periodically review providers participating in the Medicaid community mental health services program, including the certification and recertification of the provider's eligibility for enrollment in the Illinois medical assistance program (89 Ill. Adm. Code 140).

d)         The Medicaid community mental health services program is for clients who require mental health services as indicated by a diagnosis contained in the International Classification of Diseases, 9^th Revision, Clinical Modification (ICD-9-CM) (Centers for Medicare and Medicaid Services (CMMS) (2003)) or the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (DSM-IV) (1994) or DSM-IV-TR (2000) (American Psychiatric Association).  This shall include services designed to benefit clients:

1)         Who require an evaluation to determine the need for mental health treatment; or

2)         Who are assessed to require medically necessary mental health treatment  to reduce the mental disability and to restore an individual to the maximum possible functioning level; or

3)         Who are experiencing a substantial change/deterioration in age appropriate or independent role functioning, acute symptomatology, and who require crisis intervention services to achieve stabilization; or

4)         Who, because of substantial impairment in role functioning, require multiple coordinated mental health services delivered in a variety of settings.

(Source:  Amended at 32 Ill. Reg. 9981, effective July 1, 2008)