Sexual Assault Outpatient Hospital Treatment Services Rate

July 6, 2022


The Illinois Dept. of Healthcare and Family Services (HFS) has posted a provider notice to inform providers of a minimum $1,000 reimbursement for sexual assault outpatient forensic hospital services, effective July 1, 2022 (click here to access). IHA advocated for this reimbursement minimum during the 2022 spring session and language was included in Public Act 102-0699 (page 522).

This reimbursement minimum applies to outpatient forensic services provided to a sexual assault survivor and reimbursed by: HFS, Medicaid managed care organizations (MCOs), and the Illinois Sexual Assault Emergency Treatment Program (ISAETP) under HFS.

Under Public Act 102-1097 (SB 3023) signed by the Governor on June 16, the ISAETP now provides hospital reimbursement for a survivor who is not the subscriber or primary policyholder of their insurance policy and who chooses to opt out of billing their private insurance. The act also extends reimbursable follow-up care from 90 days to 180 days.

HFS asks hospitals to hold applicable electronic fee-for-service claims until they are notified that system pricing updates have been completed. Claims for the MCO population are not to be held and providers can contact the appropriate MCO for further billing information. Claims for the non-Medicaid eligible population (ISAETP) may continue to be submitted without delay to HFS on the paper UB-04. 

Questions regarding the HFS notice should be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

Contact us with any questions.