April 20, 2017
Rate Year 2018 Determinations for Disproportionate Share, Medicaid Percentage Adjustment and County Trauma Center Adjustment Payments
The Illinois Department of Healthcare and Family Services (HFS) has posted the rate year 2018 Determination for Disproportionate Share (DSH), Medicaid Percentage Adjustment (MPA) and County Trauma Center Adjustment (CTCA) payments on its website. In an effort to increase efficiency and reduce waste, HFS is no longer sending paper notices or forms for these payments to hospitals. Please see IHA’s detailed memo on information required and due dates.
New HFS Data Processing Issues Report – Hospital and Institutional Providers
HFS has posted a new report detailing known claims processing issues within its Medicaid Management Information System (MMIS). This HFS report is designed to keep providers up to date about known data processing issues. It will also provide guidance for resolution when an identified problem is being corrected and follow-up actions are taken. Providers should consult this list for updates on MMIS system issues prior to contacting HFS.
Central Illinois Region Suspension of Mandatory Managed Care Updates – Integrated Care Program (ICP), Family Health Population (FHP) Program and Medicare-Medicaid Alignment Initiative (MMAI)
HFS has issued notice to inform providers of the suspension of mandatory managed care effective May 1, 2017 for the Family Health Population (FHP) and the Integrated Care Program (ICP) for the following Southern and Central Illinois counties:
HFS also issued a notice to inform providers that effective May, 1, 2017, Molina Healthcare of Illinois (Molina) will no longer be a Medicare-Medicaid Managed Care health plan option for MMAI members in the following Southern and Central Illinois counties:
Current Procedural Terminology (CPT) Codes and Reimbursement Rates for Physical and Occupational Therapy Evaluations Effective January 1, 2017
HFS issued a notice is to inform providers of changes to physical therapy and occupational therapy evaluation CPT codes effective with dates of service on or after January 1, 2017. Notice details.
Medicaid Managed Care Expansion
HFS is expanding its current managed care program to every county in Illinois beginning on January 1, 2018. HFS also will be including the following three population groups into mandatory managed care:
- Special needs children eligible for Social Security income;
- Individuals included under the Division of Specialized Care for Children; and
- Children in the care of the Department of Children and Family Services.
HFS has recently issued a Request for Proposal (RFP) with the intent to award contracts to no fewer than four and no more than seven Managed Care Organizations (MCOs) to enter into risk-based contracts for the Medicaid managed care program. Additional details.
As a result of the Offeror Round 1 Questions and Answers, HFS has posted updates to the RFP. Additional details on the RFP, Appendix and Addendum 2.
Chapter HK-200, Handbook for Providers of Healthy Kids Services – Re-issue
The Department has re-issued the Handbook for Providers of Healthy Kids Services with changes to the Vaccines for Children program and updated provider enrollment information. It also incorporates Affordable Care Act-endorsed Bright Futures recommendations. Providers are strongly encouraged to review the entire document for current policy regarding delivery of Early and Periodic Screening, Diagnosis and Treatment program guidelines.
New Medicaid MCO Billing Guidelines for CMHCs
HFS has recently released Medicaid managed care billing guidelines for Community Mental Health Center (CMHC) services. The guide establishes the standardized claims submission processes to be utilized across HFS-contracted Managed Care Organizations (MCOs) for reimbursement of services rendered by certified and enrolled CMHCs. It is designed to provide guidance and clarification to both MCOs and CMHC certified providers. The HFS encounter claims system will accept encounter claims from MCOs in line with the standardized claims submission requirements outlined in this guide. Along with examples that demonstrate correct billing, this guidance provides specific direction on duplicate claiming.
Practitioner Fee Schedule
HFS has posted a new notice regarding the Practitioner Fee Schedule.