Community Reintegration and Support Form

Applicable product: • State of Illinois Contract Medicaid IL Policy: Blue Cross and Blue Shield of Illinois promotes community reintegration and support via an integrated health model consisting of physical health, behavioral health, care coordination, pharmacy, social work services, social agencies and community resources. Purpose: The Community Reintegration and Support program was developed to ensure that individuals between the ages of 18 and 59 who are interested in moving back into the community from a nursing facility setting are supported in this process. The goal is to identify the services and support systems that a nursing home resident may need in order to move into their own residence and live independently again. Regulatory requirements and references: • State of Illinois Model Contract: 5.21.3.2; 5.22.3; Attachment XI (Quality Assurance) 1.1.1.1; 1.1.9.; 1.1.9.12; 1.1.9.16; Attachment 12: Utilization Review/Peer Review 1.1.2.3.2; Attachment XXI: Required Minimum Standards of Care 3. Covered Services Guideline: This guideline is based on recommendations from the Community Reintegration Program Brochure. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Shield Association 255231.0126 Community Reintegration and Support 2025-2026 Clinical Practice Guidelines