State-Operated Psychiatric Hospital Diversion Payments - Nov. 4

November 4, 2021

Memorandum 

The Illinois Dept. of Human Services – Division of Mental Health (DHS-DMH) has announced  new, time-limited payments to Illinois community hospitals for treating eligible, uninsured patients in hospital inpatient psychiatric units who are diverted from State-Operated Psychiatric Hospitals (SOPHs) due to a temporary COVID-19 outbreak status requiring a pause in admissions. Between November 1 and December 31, hospitals will be reimbursed for eligible patients at a rate of $880 per diem. Funding is also available to pay for care provided prior to November 1, if the individual is still currently receiving services because they cannot be transferred to an SOPH due to a COVID-19 related pause in admissions. Following feedback from the IHA Behavioral Health Advisory Forum and discussions with IHA, DHS-DMH set aside $1 million of funds from the American Rescue Plan Act of 2021 to support this SOPH diversion program. Eligibility for the program includes:

  • Hospitals within the catchment area where an 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.

Prior to completing a DHS Uniform Screening and Referral Form and applying for these payments, please review the DHS-DMH letter for further details on eligibility, including the Contraindications for Civil Admissions to a Department of Human Services, Division of Mental Health Hospital. This form includes relative contraindications for admission to an SOPH, with exceptions dependent on specific clinical circumstances. IHA will continue to gather data from members on the impact of the COVID-19 Delta variant on diversions earlier this year, to aid in continued discussions with DHS-DMH.

Referral form submission or clinical questions for DHS can be directed to Teresa Glaze at teresa.glaze@illinois.gov or (312) 814-1626. Payment questions for DHS can be directed to Brock Dunlap at brock.dunlap@illinois.gov or (217) 622-1184.

For questions or comments, please contact IHA.