Section 148.830  Providers Participating in the Program

a)         Hospitals that may participate in the Program are limited to those included in the funded demonstration application.  A hospital participating in the Program will be designated a Community Connect IMD hospital.

b)         In order to participate in the Program, the Community Connect IMD hospital must comply with all of the Department rules, policies and licensure requirements and, additionally, must meet each of the following criteria:

1)         Establish a Network Guidance Group consisting of a representative from each of the following: Illinois Department of Healthcare and Family Services; Illinois Department of Human Services-Division of Mental Health; the Community Connect IMD hospital; the Community Connect TCM agency; and representatives from participating emergency departments, local law enforcement, consumers, and other individuals as determined by the Community Connect IMD hospital.  The Network Guidance Group shall meet at least quarterly to review the Program operations.

2)         Accept Community Connect eligible participants on a priority basis.

3)         Include the Community Connect TCM agency in staffing and discharge planning.

4)         Not discharge Community Connect participants unless a discharge plan ensures the patient has a place to go and appropriate services will be implemented.

5)         Establish a collaborative working relationship with a dedicated community mental health center to function as the Community Connect TCM agency.

6)         Contact the Community Connect TCM agency to perform a level of care assessment prior to admission.

7)         Update the collaborating Community Connect TCM agency on bed census every day.

8)         Enter into a supplemental provider agreement with the Department.

c)         In selecting hospitals for the Program, the Department may consider other factors beyond the criteria in subsection (b), including, but not limited to, the facility's history of compliance with all applicable State and federal standards.

d)         Each Community Connect IMD hospital will partner with a general acute care hospital.  The general acute care hospital will identify individuals who present in a psychiatric emergency medical condition.  The number of individuals to be admitted to a Community Connect IMD hospital under the Program will be the number in the supplemental provider agreement.  The maximum number allowed for all Community Connect IMD hospitals shall not exceed the number of individuals funded by CMMS for the Program.

e)         A Community Connect TCM agency shall be chosen for each Community Connect IMD hospital.  A Community Connect TCM agency will be chosen from the pool of qualified community mental health centers in the vicinity of the Community Connect IMD hospital and required to enter into supplemental provider agreements with the Department.  The agencies are responsible for providing crisis intervention services for Medicaid eligible individuals presenting at a participating Community Connect IMD hospital or partner hospital.  Crisis intervention shall include determination of appropriate level of care and potential stabilization of the individual.  For those individuals who are determined to be appropriate for community stabilization, the Community Connect TCM agency shall be responsible for ensuring that the participant has priority access to community services within 24 hours after stabilization. For those participants found to be appropriate for inpatient treatment and admitted to the Community Connect IMD hospital, the Community Connect TCM agency is responsible for a seamless transition for the individual from the Community Connect IMD hospital IMR treatment setting to the community mental health center IMR treatment setting.  Prior to discharge, at the point of discharge, and for up to 60 days following the level of care assessment, the Community Connect TCM agency shall act as the linkage agent, assisting the individual to connect to all available needed resources.

f)         Certified community mental health center providers who have agreed to provisions of the Program, as defined in a linkage agreement with the Community Connect TCM agency, will be a choice for community-based treatment to the individual after inpatient discharge, or after the individual is deflected from the emergency department to community services.

(Source:  Added at 37 Ill. Reg. 402, effective December 27, 2012)