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.
New Medicaid Add-on Payment: Emergency Dept. Opioid Treatment
HFS has issued a Provider Notice updating guidance on coverage and reimbursement for the initiation of medication for the treatment of MOUD in a hospital ED setting.
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.
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.
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.
Rate Year 2022 DSH Determination Oct. 20 Deadline for Appeals
HFS has posted a Provider Notice alerting hospitals of the completion of the annual Disproportionate Share Hospital (DSH) determination.
HFS Updated Inpatient and Outpatient Pricing Calculations
The Illinois Department of Healthcare and Family Services (HFS) has posted updated inpatient and outpatient pricing calculators effective July 1, 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.
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.
Hospital and Healthcare Transformation Update No. 5 Transformation Program App.
HFS has released a Provider Notice announcing the Healthcare Transformation Collaboratives Program that includes the Application for Funding Healthcare Transformation Collaboratives.
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.
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.
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.
Rate Year 2021 Safety Net Hospital Determination
HFS posted a Provider Notice alerting hospitals of the completion of the annual Safety Net Hospital determination.
HFS CARES Portal is Open
HFS has posted a Provider Notice announcing that the HFS CARES Portal is now open for CURE Fund applications.
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.
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.
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.
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.
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.
Hospital Assessment Payment Banking Information
This is a list of hospitals which need to provided banking information to MCOs to facilitate assessment payments.
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.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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
COVID-19 Behavioral Health Update
See several new updates concerning COVID-19 and hospital and health system behavioral healthcare.
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.
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.
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.
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.
Federal Fiscal Year 2020 Safety Net Determination
HFS posted a new provider notice regarding Federal Fiscal Year 2020 Safety Net Determination.
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.
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.
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.
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.
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.
New HFS Hospital Unit Telephone Hours Effective August 1, 2019
HFS extends its appreciation to IHA members and third-party billing vendors for recent efforts to reduce routine calls to the Hospital Billing and Payment Support Unit through June 30, 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.
Payments Linked to or Requiring the Provision of OB Services
This document outlines specific Medicaid payments that are contingent on providing inpatient obstetrical services.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
March-April 2018 HFS Notices
HFS notices and notifications released in March and April.