State-Operated Psychiatric Hospital Diversion Payments - April 15

April 15, 2022

Memorandum  

Hospitals that have treated eligible, uninsured patients in inpatient psychiatric units diverted from State-Operated Psychiatric Hospitals (SOPHs) due to a temporary COVID-19 outbreak status must submit all applications to the Illinois Dept. of Human Services – Division of Mental Health (DHS-DMH) by April 30, 2022. This program was successfully implemented through collaborative efforts of the agency, IHA, and member hospitals throughout the COVID-19 pandemic due to case spikes.

Details on program eligibility, application submission and further resources are outlined below.

DHS has indicated that SOPHs will discontinue unit quarantine requirements for COVID-19 positive patients on April 18 and related hospital admission pauses are expected to cease. As such, IHA will discontinue weekly SOPH quarantine update memos.

Program Eligibility
The Community Hospital Diversion Program covers qualifying psychiatric admissions from July 1, 2021 through Feb. 28, 2022. Hospitals will be reimbursed for eligible patients at a rate of $880 per diem. Additional eligibility requirements for the program include:

  • Hospitals within the catchment area where a SOPH is experiencing a pause in admissions due to COVID-19 outbreak status; or
  • Individuals who reside in the SOPH catchment area, but due to community hospital capacity, may be receiving care in a community hospital outside the normal SOPH catchment area.

IHA’s SOPH Diversion Program table provides a snap shot of the dates of hospital admission pauses from July 1, 2021 to current, in order to determine patient eligibility for SOPH diversion payments.

Prior to application submission, review the Contraindications for Civil Admissions to a Department of Human Services, Division of Mental Health Hospital. This resource includes relative contraindications for admission to an SOPH, with exceptions dependent on specific clinical circumstances.

Application Submission
Hospitals must have reimbursement requests, including invoices and contracts, submitted to DHS-DMH by April 30. To submit reimbursement requests, hospitals must complete a DHS Uniform Screening and Referral Form (USARF) and email it to teresa.glaze@illinois.gov. Patient referral date (to compare with SOPH admission pauses due to COVID-19) and length of stay may be reflected in the “Comments” section of the form (page 3).

Resources For More Information
If you have questions about patient eligibility, please reach out to the admissions unit in the SOPH where you would normally have sent the referral, or contact Teresa Glaze, PhD at teresa.glaze@illinois.gov. If you have contractual questions after eligibility is approved, please contact Jason Buckhold at jason.buckhold@illinois.gov. For more background on the criteria and procedures required to participate in the program, see the latest DHS-DMH letter extending the program’s eligibility dates.

Contact us for any additional questions or comments.