4521. Psychological/Psychiatric Services

Service Definition

  1. Services to provide psychiatric and psychological evaluations and treatment to implement a permanency plan, to prevent CA/N, to prevent out-of-home placement, or to make placement/permanency planning decisions. See section 4539, below, for information regarding Inpatient Mental Health Treatment for Children. In general, there are two main types of psychological/psychiatric funding sources available for utilization by DCFS: Title XIX/Healthy Kids (EPSDT) services through the Regional Support Networks (RSN) and DCFS direct funded services.
  2. The RSNs in the state are the conduit for mental health services for recipients of Medicaid. Serving as Prepaid Health Plans, these networks receive and distribute all state and federal mental health dollars to the community mental health centers, institutions, and other certified mental health providers.


  1. Under Healthy Kids Services, Medicaid-eligible children and their families are provided specific mental health evaluation and treatment. For eligible children under 19 years of age, mental health services must be determined to be medically necessary as a result of a Healthy Kids/EPSDT health screen.
  2. Medicaid-funded mental health services must be the first choice for treatment. DCFS-funded services are to be used only when all other payment resources have been exhausted. Families or children are eligible for DCFS direct-funded psychological/psychiatric services under the following circumstances:
    1. Parents or children with an active CPS, FRS, or CWS case.
    2. All RSN resources have been exhausted or the child/parent is not eligible to receive the service under a Healthy Kids plan.
    3. The child/family has demonstrated it doesn't have the financial resources or insurance to pay for the service.
    4. Funding is available to provide the service.
    5. Services are only available from DCFS-contracted providers.

Procedures for Access

  1. Unless the child has already been referred, the caseworker will ensure a mental health referral is made within five working days of receiving notification from the CHET screening specialist that a mental health need has been identified.
  2. Children and families can access RSN funding by presenting at any mental health provider which is certified to accept Medicaid. For Healthy Kids services, the following steps shall be taken:
    1. The caseworker refers Medicaid-eligible children and families for a Healthy Kids screening utilizing regional procedures.
    2. If the child does not have a current Healthy Kids/EPSDT examination, the caseworker must schedule a Healthy Kids examination to be completed within 30 days.
    3. For situations involving inpatient treatment, see section 4539, below.
    4. DCFS caseworkers supply mental health screeners and providers with the information they request to make screening decisions and to provide mental health services.
  3. For DCFS direct-funded psychological/psychiatric services, the following steps shall be taken:
    1. The caseworker determines that Healthy Kids services are not available and that funding is not available for the service through other sources listed below.
    2. The caseworker authorizes psychiatric/psychological services utilizing the authorization guidelines in paragraph A above and regional procedure.
  4. The caseworker authorizes psychological/psychiatric procedures using current SSPS codes and sends a copy of the authorization to the provider.
  5. The caseworker requests a final report and terminates payment.

Other Sources

  1. If the need for the service is primarily to support the child's ability to stay in school, funds for evaluations/treatment may be available through the local school district. The caseworker may contact the child's school, or have the child's family contact the school, and make a referral to determine if the child is eligible for special education services.
  2. DDD may provide psychiatric/psychological evaluations and/or behavior management training or treatment for developmentally disabled children living in their own homes or parents.
  3. The JRA or local juvenile probation offices may provide similar services for delinquent children.
  4. Division of Vocational Rehabilitation (DVR), General Assistance-Unemployable (GA-U), and SSI evaluations may be a resource. If the child has a current or recent SSI application, the caseworker shall ask the SSI facilitator to access the SSI file for current medical or psychological assessments.