I want to thank IARF for a great conference this week. Krescene
Beck from the Illinois Self Advocacy Alliance, Robby Stevens, self advocate and
Anne Taylor from Marcfirst and I were able to present to more than 75 people
about engaging people with disabilities and families in advocacy.
At 11 am today, we are holding a modified version of our supported employment training through the Supported Employment Action Team (SEAT) project funded by the Illinois Council on Developmental Disabilities and staff from DRS and DDD. We will be recording it and posting it on our website as well.
Don’t miss the Sept 12 event with the PERC at the end of this email.
Medicaid Changes – Updated
As we shared last week, there are changes coming to Medicaid reimbursement requirements. Below is a DDD notice that has been written to help people and families ensure that they can get paid/reimbursed for prescriptions and referrals from doctors who currently are not enrolled as Medicaid providers.
Here is the update we share last week. Two clarifications that parents asked about last week.
Question: Please let me know how I can access the Illinois Medicaid Provider Manual mentioned in your email to see if a provider is listed?
Answer: Enrollhfs.illinois.gov to find providers/Enroll HFS
Question: Do you know if a specialist in another state can be an Illinois Medicaid approved doctor?
Answer: Any medical provider: doctor, hospital, specialist, in ANY state can enroll with IL Medicaid. (Most big teaching hospitals in many states are already enrolled with IL Medicaid)
From DDD – Official Notice from yesterday
On November 9, 2018, Healthcare and Family Services (HFS) provided a notice to Medical Providers of a change which requires all practitioners who order, refer, or prescribe Medicaid services to be enrolled through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) as a participating Physician, Dentist, Optometrist, Podiatrist, Advanced Practical Nurse or a Physician Assistant. This change was to take effect on January 1, 2019. The notice can be found at the following link: https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn181109c.aspx
On December 28, 2018, and again on June 25, 2019, HFS provided additional notices delaying the implementation of this change. Those notices can also be found at the following links:
https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn181228a.aspx (December 28, 2018)
https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn190625b.aspx (June 25, 2019)
Unfortunately, HFS can no longer delay the implementation of this policy change and it’s set to be effective October 1, 2019. HFS has made it clear to the Division, the policy change can’t be delayed again, or Illinois will not be in compliance with the federal Centers for Medicare and Medicaid Services (CMS).
Many of the provider associations and participant associations have been sharing this impending change with their membership. The Division is providing this notice to follow up with similar information to ensure the widest spread of this communication.
BOTTOM LINE: If the prescribing doctor is NOT enrolled with IL Medicaid, IL Medicaid will not pay for the item/service to include: drugs, durable medical equipment, diapers, referrals to another doctor…etc.
THIS POLICY CHANGE AFFECTS: Any person who is enrolled in Traditional Medicaid. It also applies to individuals who are “dual eligible” (having both Medicare and IL Medicaid.) The requirement that physicians be enrolled will extend to crossover claims (where Medicare is primary, and Medicaid is secondary). To receive the 20% payment from Medicaid, the prescriber(s) will need to be enrolled with IL Medicaid.
This does NOT YET apply to individuals enrolled in a Medicaid MCO (Managed Care Organization). They will be following this requirement at a later date.
EXCEPTION: Drugs filled by Medicare Part D. IL Medicaid does not pay secondary to Medicare Part D, except in a very limited circumstance. When a pharmacy bills Medicare Part D, the Medicare Part D plan is responsible for the entire cost of the drug, even if the member is dual eligible for both Medicare and Medicaid. IL Medicaid allows Medicare Part D copay only billing for a very small subset of individuals who are not eligible for a waiver and live in a specific type of supported living arrangement. This policy would apply to those claims.
WHAT HAPPENS IF I GO TO THE PHARMACY AND MEDICAID WILL NOT PAY FOR MY DRUG:
IL Medicaid has explained there will be a one-time (per drug) override for the first month (October 2019). To get an override, you would need to call: 877-782-5565.
This leaves families and DD Waiver participants with a couple options:
- Change to a doctor who is enrolled with IL Medicaid. We realize this isn’t a simple change or option. To find a doctor who is currently enrolled with traditional IL Medicaid, you may call: 800-226-0768.
- The current non-Medicaid doctor can enroll with IL Medicaid. A physician can register in IMPACT to become a Medicaid enrolled provider. After Medicaid enrollment, this doctor can choose to accept Medicaid patients or choose not to see Medicaid patients, but his/her prescriptions will be paid by IL Medicaid for patients eligible for IL Medicaid.
Important Phone Numbers:
- If you, as a Medicaid participant have questions, please call 800-226-0768.
- If a Medical Provider has questions, please call the provider billing hotline at 877-782-5565.
Should the Division receive more information on
this impending change, we will share it through this communication. If you have
questions and need to e-mail them, please send them to Derek.Hedges@Illinois.gov.
Thank you for your immediate attention to this matter.