HFS Notices and Policies

The Illinois Department of Healthcare and Family Services (HFS) is a key resource for important provider notices and policies. Updates from IHA policy experts will also be posted here.
Nov 15, 2023

HFS-IHA Webinar on Recovery Audits

IHA hosted a joint webinar with the Dept. of Healthcare and Family Services, the Department’s Office of the Inspector General, and the OIG’s Recovery Audit Contractor, HMS Gainwell, on Nov. 1, 2023.

Sep 30, 2021

HFS Rate Year 2022 Safety Net Hospital Determination

The Illinois Department of Healthcare and Family Services has posted the annual Safety Net Hospital determinations effective Oct. 1, 2021.

Sep 30, 2021

HFS Directed Payment and Passthrough Calculations Posted on HFS Website

The Illinois Department of Healthcare and Family Services has issued a notice announcing that the Oct. – Dec. MCO Hospital Access Program Payments have been posted to its website.

Sep 21, 2021

Rate Year 2022 DSH Determination – Oct. 20 Deadline for Appeals

HFS' Provider Notice alerts hospitals of the completion of the annual Disproportionate Share Hospital  determination, as well as the annual Medicaid Percentage and Medicaid High Volume adjustments.

Jul 06, 2021

HFS’ Updated Inpatient and Outpatient Pricing Calculators

The Illinois Dept. of Healthcare and Family Services has posted updated inpatient and outpatient pricing calculators effective July 1, 2021.

Apr 27, 2021

Updated Family Support Program Guidance

On April 26, HFS issued a Provider Notice providing updated Family Support Program guidance during the COVID-19 pandemic to hospitals and community mental health centers.

Apr 19, 2021

HFS COVID-19 Vaccine Administration Performed in Hospital-Based Outpatient Settings

HFS posted a Provider Notice informing hospitals that it will cover vaccine administration costs, specifically in hospital-based outpatient settings.

Mar 09, 2021

Hospital and Healthcare Transformation – Update No. 5: Transformation Program Application

HFS has released a Provider Notice announcing the Healthcare Transformation Collaboratives Program that includes the Application for Funding Healthcare Transformation Collaboratives.

Feb 26, 2021

Illinois Department of Healthcare and Family Services COVID-19 Update

HFS has two new provider notices: 1) announcing the HFS CARES program reporting template is available; 2) Repricing Hospital Outpatient Claims Billed with COVID Diagnosis and Procedure Codes.

Dec 16, 2020

Medicare-Medicaid Alignment Initiative (MMAI) Statewide Expansion New Effective Date: July 1, 2021

HFS issued a Provider Notice to advise providers that the previously delayed statewide expansion of the Medicare-Medicaid Alignment Initiative (MMAI) is now scheduled to begin July 1, 2021. 

Dec 15, 2020

Health Benefits for Immigrant Seniors

HFS issued a Provider Notice (Dec. 11, 2020) to implement a new, state-only funded Medicaid eligibility category—Health Benefits for Immigrant Seniors.

Oct 16, 2020

IHA Update – Medicaid Integrated Health Homes

On Oct. 15, the Dept. of Healthcare and Family Services issued a notice with updates on Medicaid behavioral health service reimbursement and care coordination plans for 2021.

Sep 30, 2020

Rate Year 2021 Safety Net Hospital Determination

HFS posted a Provider Notice alerting hospitals of the completion of the annual Safety Net Hospital determination. 

Sep 29, 2020

HFS CARES Portal is Open

HFS has posted a Provider Notice announcing that the HFS CARES Portal is now open for CURE Fund applications.

Sep 28, 2020

HFS Billing Guidance: Lab Testing and Claims Submittal Related to COVID-19

HFS posted a Provider Notice updating information regarding its upcoming deployment of an online portal that will allow providers to bill for COVID-19 testing services for patients.

Sep 22, 2020

FY2021 Disproportionate Share Hospital (DSH) Determination

HFS posted a Provider Notice on the completion of the annual Disproportionate Share Hospital determination, as well as the annual Medicaid Percentage and Medicaid High Volume Adjustments.

Aug 11, 2020

Repricing Hospital Outpatient Claims Billed with COVID-19 Diagnosis and Procedure Codes

HFS issued a provider notice, advising hospitals that certain outpatient claims containing COVID-19-related coding will be reprocessed. 

Aug 07, 2020

Hospital Assessment – UPDATED Tax Due Date & July Payment Updates

HFS issued a provider notice, stating that the updated due date for the July 2020 hospital assessment tax is now August 14, 2020. 

Jul 25, 2020

July MCO Assessment Payments Request for Banking Information

IHA was advised by HFS and all five MCOs that banking information for several hospitals is necessary for the MCOs to execute payment of the Hospital Assessment Directed and Pass Through payments. 

Jul 24, 2020

Hospital Assessment Payment Banking Information

This is a list of hospitals which need to provided banking information to MCOs to facilitate assessment payments.

Jul 23, 2020

IHA Memo re: Medicaid Reimbursement for Inpatient Days Beyond Medical Necessity

This memo summarizes IHA’s concerns about proposed rules on a new methodology for hospitals inpatient days beyond medical necessity.
Jul 22, 2020

IHA Letter re: HFS Proposed Rules on Reimbursement for Days beyond Medical Necessity

IHA raises concerns about proposed rules on a new reimbursement methodology for hospital inpatient days beyond medical necessity.

Jul 14, 2020

Reinstatement of ORP Edit, Inpatient Claims Containing LARC Device Codes

The Dept. of Healthcare and Family Services has issued two important notices on the ORP edit and LARC HCPCS codes.

Jul 01, 2020

HFS Notices Issued in May 2020 through June 2020

In May through June 2020, the Department of Healthcare and Family Services issued several notices that may or will impact hospitals. 

Jun 26, 2020

Update #1: Medicaid Hospital Outpatient FFS Billing Transition to Institutional Billing

All hospital OP services billed to HFS and MCOs must be billed uniformly on an institutional claim and will be reimbursed under EAPG, effective for claims with “From” DOS on or after July 1, 2020.

Jun 25, 2020

HFS Proposed Rules on Reimbursement for Days beyond Medical Necessity

This memo summarizes an HFS proposed rule on reimbursement to hospitals for stays beyond medical necessity and IHA’s concerns.

Jun 24, 2020

SFY 2021 Outpatient High Volume Hospital Determination

HFS has issued a notice regarding SFY 2021 outpatient high volume hospital determination.  All appeals must be submitted by July 23, 2020.

Jun 12, 2020

Correction 2Q 2020 MCO-HAP Payments

HFS released a notice that identifies a correction process for the Quarter 2 2020 managed care organization hospital access program payments (MCO-HAP).

Jun 11, 2020

FAQs on Hospital Professional Billing Transition to the Outpatient Institutional Billing

The Illinois Department of Healthcare and Family Services (HFS) has posted a new document, FAQs for Hospital Professional Billing Transition to the Institutional Claim Format.

Jun 03, 2020

Hospital Professional Billing Transition to the Outpatient Institutional Billing

HFS: all hospital OP services billed on a professional claim and paid under the Practitioner Fee Schedule will be billed on an institutional claim and reimbursed at EAPG, effective July 1, 2020. 

May 06, 2020

HFS Notices Issued in March 2020 through April 2020

The Department of Healthcare and Family Services (HFS) has issued several notices that may impact hospitals. 

Apr 15, 2020

CMS Issues Partial Approval of Medicaid COVID-19 Section 1135 Waiver Request

CMS issued partial approval of the Section 1135 request to waive certain federal Medicaid, CHIP, and HIPAA regulations during the COVID-19 public health emergency.

Apr 13, 2020

Rate Year 2021 Determinations for DSH, MPA and CTCA Adjustment Payments

HFS posted the rate year 2021 Determination for Disproportionate Share, Medicaid Percentage Adjustment  and County Trauma Center Adjustment payments in a notice on its website.

Apr 08, 2020

COVID-19 Proposed Medicaid Eligibility & Enrollment Changes

To expand access to coverage during COVID-19, HFS submitted formal requests to CMS to modify the CHIP eligibility and enrollment processes.

Apr 03, 2020

COVID-19 Behavioral Health Update

See several new updates concerning COVID-19 and hospital and health system behavioral healthcare.

Apr 01, 2020

IHA COVID-19 Telehealth Update #1: State Coverage and Reimbursement

Governor Pritzker issued an Executive Order and HFS issued Emergency Rules (89 Ill. Adm. Code 140.403(e)) and a Provider Notice, all focused on telehealth coverage and reimbursement.

Mar 02, 2020

HFS Notices Issued in December 2019 through February 2020

The Department of Healthcare and Family Services (HFS) has issued several notices that may impact hospitals. IHA also sent memos to members concerning some of these notices.

Nov 25, 2019

HFS Notices Issued in September through Mid-November 2019

Between September and mid-November 2019, HFS issued several notices that may impact hospitals. IHA sent memos to members concerning some of these notices.

Oct 30, 2019

Medicaid ORP Requirement Delayed to January 1, 2020

The Illinois Dept. of HFS informed IHA that implementation of the Ordering/Referring/Prescribing (ORP) requirement has been delayed to Jan. 1, 2020.

Sep 30, 2019

Federal Fiscal Year 2020 Safety Net Determination

HFS posted a new provider notice regarding Federal Fiscal Year 2020 Safety Net Determination.

Sep 24, 2019

Attending Provider NPI Requirements Delay to November 1, 2019

On Sept. 23, 2019, HFS released two notices: 1) Attending Provider NPI Requirements Delay to November 1, 2019; and 2) Ordering/Referring/Prescribing Provider Enrollment and Provider Directory.

Sep 19, 2019

HFS Distribution of Rate Year 2020 DSH, MPA and MHVA Determination & Rates

HFS posted the Rate Year 2020 DSH, MPA and MHVA determination and rates on its website. HFS will not mail these notification letters. Please review your calculations in detail.

Sep 09, 2019

ABE Partner Portal Report of Birth is Live

The Report of Birth functionality in the Application for Benefits Eligibility Partner Portal is now live. The HFS notice includes frequently asked questions.

Sep 04, 2019

HFS Notices Issued in July and August 2019

HFS has issued several notices that may impact hospitals. IHA has sent memos to members concerning some of these notices.
 

Aug 16, 2019

Hospitals Must Use New PCS Form for Non-Emergency Ambulance Transfers Under Medicaid

Hospitals are urged to review their policies and procedures to assure that they are complying with the updated Physician Certification Statement.

Jul 30, 2019

New HFS Hospital Unit Telephone Hours – Effective August 1, 2019

To further reduce the backlog of hard copy claims, the Hospital Billing and Payment Support Unit will only take telephone inquiries Tuesdays and Thursdays from 8:30 to 4.

Jul 25, 2019

HFS FY2020 Hospital Inpatient & Outpatient Assessment Program Notice

HFS has posted a notice indicating that it has mailed each hospital the facility’s inpatient and outpatient assessment remittance notices for FY2020. 

Jul 09, 2019

Payments Linked to or Requiring the Provision of OB Services

This document outlines specific Medicaid payments that are contingent on providing inpatient obstetrical services. 

Jul 08, 2019

HFS Notices Issued May-June 2019

The Illinois Dept. of Healthcare and Family Services released notices on numerous issues, including ABE, NPI requirements, APR-DRG and EAPG, and MMAI.

Jun 25, 2019

HFS Delays Medicaid Ordering/Referring/Prescribing NPI Requirement

The Illinois Dept. of Healthcare and Family Services (HFS) has informed IHA that it will delay until October 1, 2019 implementation of the ordering, referring, prescribing (ORP) requirement.

Jun 25, 2019

HFS Update: New Inpatient APR-DRG and Outpatient EAPG Grouper Version

The Illinois Dept. of Healthcare and Family Services announced it will use Grouper Version 3.13 of the Enhanced Ambulatory Patient Groups (EAPG) payment system.

Apr 08, 2019

Rate Year 2020 Determinations for DSH, MPA and CTCA Adjustment Payments

The Dept. of Healthcare and Family Services has posted rate year 2020 determinations for DSH, MPA and CTCA payments in a notice on its website.

Jan 03, 2019

HFS Notices and Notifications Issued Nov.-Dec. 2018

The Illinois Dept. of Healthcare and Family Services released notices on numerous issues, including Integrated Health Homes, NPI requirements and non-emergency ambulance transfers.

Oct 25, 2018

HFS Notices and Notifications Issued Late August through October

The Illinois Dept. of Healthcare and Family Services released notices on a Hospital Assessment payment extension, FFY2019 DSH and Safety Net determinations and other issues from Aug-Oct.

Aug 15, 2018

May-August 2018 HFS Notices

The Illinois Dept. of Healthcare and Family Services released notices on assessments, reimbursement systems, laboratory services and a standardized "provider roster" from May through early August.

Aug 07, 2018

Updated Pricing Calculators

The Illinois Department of Healthcare and Family Services has posted a new provider notice regarding Updated Pricing Calculators, related to the redesigned Hospital Assessment Program.

Jul 02, 2018

Fee-for-Service ACA Hospital Access Payments and ACA Assessment Reconciliation Adjustment

HFS has informed IHA that the state has also received approval from CMS to pay the Fee-for-Service ACA payments.

Jun 29, 2018

HFS Notice: Changes to Hospital Inpatient and Outpatient Reimbursement Systems

HFS notice regarding changes applicable to fee-for-service payments effective with dates of service on and after July 1, 2018.

May 15, 2018

Modifier 90 for Reference Labs

HFS has clarified a new requirement for hospitals to report Modifier 90 on certain outpatient claims for reference laboratory service.

May 03, 2018

March-April 2018 HFS Notices

HFS notices and notifications released in March and April.