Provider Notice issued 06/29/12

Coverage Changes Resulting from the Save Medicaid Access and Resources Together (SMART) Act

Governor Quinn signed into law Public Act 097-0689 (pdf) on June 14, 2012. Termed the SMART Act, this law becomes effective July 1, 2012, and requires the Department of Healthcare and Family Services (HFS) to revise coverage available through the Medicaid Program.

Among the service changes affecting long term care facilities as a result of the SMART Act are:

• NFs and IMDs will see an average 2.7% rate decrease, though this percentage may vary between facilities based on the clinical characteristics of Medicaid-eligible residents. Rate Sheets with each facility’s revised reimbursement rate will be sent to each facility.

• Payment for bed reserve has been discontinued for all long term care residents with the exception of ICF/DD residents under the age of 21 years.

• The minimum Determination of Need score has been increased from 29 to 37 points. This change will not be implemented until approval by the federal Centers for Medicare and Medicaid Services is received.

• The Community Spouse Resource Amount (resource - which was formerly termed assets) and Community Spouse Maintenance Needs Allowance (income) when one spouse enters a LTC facility and the other remains in the community has been reduced to the 2010 amounts of $109,560 resources and $2,739 monthly income.

• Services determined to be optional under federal requirements that will be discontinued will include group psychotherapy (except ICF/DDs) and adult chiropractic. Service coverage to be reduced includes adult optical (glasses every two years), adult dental (emergency extraction only), adult podiatric (available only to diabetics).

• Prescriptions for pharmaceuticals will be restricted to four prescriptions, including three name bands in 30 day period. Exceptions may be possible with prior approval. Long term care residents will be restricted to a 14-day supply for each medication.

• When a new medical assistance application for long term care, supportive living or other Home and Community Based Services waiver placement is being reviewed or an annual redetermination of eligibility is being performed by the Department of Human Services an additional review of resources will be performed by the Office of the Inspector General.

• The “look back” period for review of resource and income transfers will change from 36 months to 60 months. This will affect any transfers that occurred on or after 1/1/2007.

You may view Public Act 097-0689 (pdf) on the HFS Web site.

If you have questions, contact HFS’ Bureau of Long Term Care at 217-524-7245.

Theresa A. Eagleson, Administrator

Division of Medical Programs