BEHAVIORAL HEALTH SERVICES PROVIDER IN ILLINOIS

PROMOTING EMOTIONAL WELL-BEING, RECOVERY, AND COMMUNITY INTEGRATION THROUGH INDIVIDUALIZED SUPPORT

Behavioral Health Services in Illinois provide assessment, diagnosis, counseling, therapy, and support services to individuals experiencing mental health conditions, substance use disorders, or behavioral challenges. These services are authorized under the Illinois Medicaid State Plan and Home and Community-Based Services (HCBS) Waiver programs to promote recovery, independence, and full community participation.

1. GOVERNING AGENCIES

Agency: Illinois Department of Healthcare and Family Services (HFS) — Behavioral Health Division

Role: Administers Medicaid funding for Behavioral Health Services, oversees provider enrollment, service delivery standards, and billing compliance

Agency: Illinois Department of Human Services (DHS) — Division of Mental Health (DMH) and Division of Substance Use Prevention and Recovery (SUPR)

Role: Regulates behavioral health providers, ensures service quality, coordinates statewide mental health and substance use initiatives

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Medicaid Behavioral Health Services meet HCBS settings standards, person-centered care principles, and medical necessity requirements

2. BEHAVIORAL HEALTH SERVICE OVERVIEW

Behavioral Health Services support individuals in managing mental illness, emotional disturbances, and/or substance use disorders through therapeutic interventions, skill development, and recovery-oriented services.

Approved providers may deliver:

• Behavioral health assessments and diagnostic evaluations

• Individual, group, and family psychotherapy

• Psychiatric services (e.g., medication evaluation and management)

• Crisis intervention and stabilization services

• Community support services (case management, recovery coaching)

• Substance use treatment and harm reduction counseling

• Psychoeducation on symptom management, coping skills, and wellness planning

• Behavioral intervention plans for individuals with developmental or behavioral disorders

All services must align with the participant’s Individualized Service Plan (ISP) or Treatment Plan and focus on supporting recovery, stability, and quality of life.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Illinois Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Enroll as a Medicaid Behavioral Health Provider through the Illinois Medicaid Provider Enrollment Portal (IMPACT system)

• Obtain necessary behavioral health facility licensure and/or accreditation (e.g., DHS DMH certification, SUPR licensure for substance use treatment programs, Joint Commission accreditation preferred)

• Maintain general liability and professional malpractice insurance

• Develop clinical policies covering assessment, service planning, behavioral interventions, participant rights, emergency response, and confidentiality

• Ensure all clinical staff meet licensure, credentialing, background checks, and continuing education requirements

4. ILLINOIS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application through the IMPACT system for Behavioral Health Services

Application and Documentation Submission:

• Provide Articles of Incorporation, proof of EIN/NPI, clinical staff licensure documentation, insurance certificates, operational policies, and service protocols

Program Readiness Review:

• DHS DMH/SUPR and HFS review service delivery standards, clinical supervision protocols, client rights protections, emergency response systems, and documentation procedures

Approval & Medicaid Enrollment:

• Upon approval, providers are assigned billing codes for mental health assessments, therapy services, crisis interventions, community-based supports, and psychiatric services

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Illinois Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Behavioral Health Facility Licensure or Certification (if applicable)

• Proof of general liability and professional malpractice insurance

• Behavioral Health Services Policy & Procedure Manual, including:

  • Participant intake, mental health assessment, and treatment planning procedures

  • Psychotherapy, community support, crisis response, and psychiatric service protocols

  • Critical incident reporting, suicide prevention, and risk management policies

  • Participant rights, grievance procedures, and HIPAA confidentiality standards

  • Staff credentialing, licensure verification, supervision, and competency evaluation records

  • Medicaid billing, clinical documentation, and audit readiness systems

6. STAFFING REQUIREMENTS

Role: Clinical Director / Behavioral Health Program Supervisor

Requirements: Licensed Clinical Social Worker (LCSW), Licensed Clinical Professional Counselor (LCPC), Licensed Psychologist (PhD/PsyD), or Licensed Psychiatrist (MD/DO); supervisory experience preferred; background clearance

Role: Licensed Clinicians (LCSWs, LCPCs, LMFTs, Psychologists, Psychiatrists)

Requirements: Active Illinois licensure; CPR certification preferred; background screening clearance

Role: Community Support Specialists / Recovery Coaches (for community-based services)

Requirements: Bachelor's degree in social work, psychology, human services, or related field preferred; experience supporting individuals with behavioral health needs; background clearance

All staff must complete:

• HIPAA confidentiality and participant rights training

• Abuse prevention, mandatory reporting, and suicide prevention training

• Crisis response and de-escalation techniques training

• Infection control and emergency preparedness training

• Annual continuing education and clinical competency assessments

7. MEDICAID WAIVER PROGRAMS AND STATE PLAN COVERAGE

Behavioral Health Services are reimbursed through:

• Illinois Medicaid State Plan Behavioral Health Services: Including outpatient mental health services, psychiatric services, substance use treatment, and crisis intervention

• Adults with Developmental Disabilities Waiver: For behavioral therapy services to support individuals with co-occurring developmental disabilities and mental health needs

• Children and Young Adults with Developmental Disabilities Waiver: For positive behavioral support services

• Persons with Brain Injury (BI) Waiver: For behavioral support services related to cognitive and emotional regulation challenges

Approved providers may deliver:

• Diagnostic assessments and psychiatric evaluations

• Outpatient mental health and substance use therapy

• Behavioral intervention planning and implementation

• Crisis response and stabilization support

• Community integration and skill-building services

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing/Accreditation Preparation

Timeline: 2–4 months

Phase: Staff Hiring, Credentialing, and Behavioral Health Program Development

Timeline: 3–6 months

Phase: IMPACT Medicaid Provider Enrollment and DHS Readiness Review

Timeline: 60–120 days

Phase: Medicaid Billing System Setup and Behavioral Health Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Illinois Department of Human Services (DHS) — Division of Mental Health (DMH)

Website: https://www.dhs.state.il.us/page.aspx?item=29728

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ILLINOIS BEHAVIORAL HEALTH SERVICES PROVIDER

WCG assists behavioral health providers, outpatient therapy clinics, and community mental health organizations in launching Medicaid-compliant Behavioral Health Services across Illinois.

Scope of Work:

• Business registration, Medicaid enrollment, and DHS DMH/SUPR certification assistance

• Development of Behavioral Health Services Policy & Procedure Manual

• Staff credentialing templates, intake forms, treatment plan templates, and progress tracking systems

• Medicaid billing system setup and audit-ready claims management support

• Website, domain, and professional branding development

• Behavioral health treatment protocols, crisis response templates, and service monitoring tools

• Quality assurance programs for clinical supervision, incident reporting, and participant satisfaction surveys

• Community outreach, hospital partnership development, and referral network strategies

Continue To Our Client Portal To Get Started

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